KaliKosmos Travel

Credit 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:

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Signature Certificate
Document name: Credit Card Authorization
lock iconUnique Document ID: cc03609f51da79ad9c52ef4100e0928fb545ea36
Timestamp Audit
November 21, 2020 8:48 pm CDTCredit Card Authorization Uploaded by Katie Hartman - forms@kalikosmos.com IP 172.58.68.105