KaliKosmos Travel

Credit Card Authorization

Travel Leaders/KaliKosmos Travel
Credit Card Authorization

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


 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
lock iconUnique Document ID: d51852c5a987f49e2ca21be896fe9c8010702615
Timestamp Audit
November 21, 2020 8:48 pm CDTCredit Card Authorization Uploaded by Katie Hartman - forms@kalikosmos.com IP