KaliKosmos Travel

Credit Card Authorization Form


Travel Leaders/KaliKosmos Travel
Credit Card Authorization


 Card Holder:  
 Street Address:  
City:   State:   Zip:  
Phone:  

 

 Card Number:  
Exp:   Security Code:  

 

 

Total amount to charge: $  

 

By signing this form I authorize the above credit card to be on file for future payments and am aware that all payments carry with them restrictions and/or penalties once applied.

Sometimes charges will be made in international currency. Foreign purchase fees from credit card companies may apply.

Client assumes all risk and responsibilities associated with using debit cards for payments.

Leave this empty:

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Signature Certificate
Document name: Credit Card Authorization Form
lock iconUnique Document ID: d33dba1759d2db9c4101fae9421445615b52e39c
Timestamp Audit
January 15, 2021 10:45 pm CDTCredit Card Authorization Form Uploaded by Katie Hartman - forms@kalikosmos.com IP 172.58.68.105