Credit Card Authorization Form

Please print this form and fax the completed copy to 503-296-5304 (USA) or 00977-1-4784475 (Nepal).
Payments will be processed within two (2) business days.

I, hereby, authorize J & P International LLC on behalf of Thamel Dot Com Pvt Ltd. to process a charge on my Credit Card, for the amount I've been credited as per their invoice for my order. I certify that I will use a genuine Credit Card, which I am authorized to charge. I enclose with this letter a Credit Card and Photo ID that I hold as a measure to certify my authenticity.
Card Details:
Invoice / Gift Order Number: __________________
Type: VISA [ ] / Master Card [ ] / AMEX [ ]
Name on Card: ________________________________________________________________________________________________
Card Number: _________________________________________________________________________________________________
Expiry: ________ / _____________ (Month / Year)
Amount: __________________________  In words ( ______________________________________________________________________ )


Signature on the Card: ___________________________
Other Details
Street: _________________________________________________________________________________
City: __________________________ State/Province: _______________
Country: _______________________ Zip/Postal Code: ______________
Telephone: _____________________ Email: _________________________

Place a photocopy (back and front) of your credit card and Photo ID here: