KaliKosmos Travel

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: Card Authorization
lock iconUnique Document ID: 4bb76d8eb09d257a1d748da2850a99ce9dd0100b
Timestamp Audit
January 16, 2021 11:46 am CDTCard Authorization Uploaded by Julie Grauf - julie@kalikosmos.com IP
January 16, 2021 11:47 am CDT Document owner forms@kalikosmos.com has handed over this document to julie@kalikosmos.com 2021-01-16 11:47:49 -