KaliKosmos Travel

Card Authorization


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:

Signature arrow


Signature Certificate
Document name: Card Authorization
lock iconUnique Document ID: d0441ebd1006c01e32014891a7a959e647c99a14
Timestamp Audit
January 15, 2021 11:15 pm CDTCard Authorization Uploaded by Katie Hartman - forms@kalikosmos.com IP 24.253.247.44