Card Holders name and address
(Your Address must be the same as Billing address recorded into Credit Company)

To,
Exclusive 
G-1, Mangal Severa. Talmiki Road.
Santacruz - West
Mumbai - 400 054  ( India )

Date:-____________

Dear Sir,



Amount [] US $ _______ or  [] Rupee ___________

(In figure                            ).

I authriozed you to charge / debit into my credit card a/c, details of which
are as under:-

Card No : ______________________________________________________

Expiry Date :  ___________________________________________________

Card Holder's Name :  ____________________________________________

Amount : ______________________________________________


Thanking You

Yours Faithfully


(Signature of Card Holder)


Also send us the additional information along with the above letter.


Name :


Home Phone Number :

Billing Address :

Colour of the Card :

Bank Name on the Card :

Date of Birth :


Note:
Kindly fax us the above letter on your personal
letterhead on fax Number
(91-22-8215249 or 91-22- 6234528 )