Card Holders name and address
To,
Nisha's
PaperBox House,
Mahakali Caves Road,
Andheri (East), 
Mumbai - 400 002,
India.
Date:-____________

Dear Sir,
I would like to place an order for services etc  amounting to Rs _______
(In figure                            ).I request you to debit my card a/c,
details of which are as under:-

Card No:- ______________________________________________________

Expiry Date:- ___________________________________________________

Card Holder's Name:- ____________________________________________

Amount in Rupees:- ______________________________________________


Thanking You

Yours Faithfully



(Signature of Card Holder)


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


Name :

Passport Number :

Home Phone Number :

Billing Address :

Social Security Number :

Mother's Maiden Name :

Colour of the Card :

Bank Name on the Card :

Name of the joint account Holder :

Date of Birth :

Account held Since :

Note:
Kindly fax us the above letter on your personal
letterhead on fax Number (91-22-8215249 OR 91-22-6231958)