Credit Card Authorization

Travel Leaders/KaliKosmos Travel
Credit Card Authorization

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

Card Number:
Exp:	Security Code:

Upload a copy of the front of the card holder's ID

Upload a copy of the front of the card

Upload a copy of the back of the card

I authorize KaliKosmos Travel independently contracted with Leone Travel d.b.a Travel Leaders ("The Agency") to use this information to make payments directly to travel service suppliers on my behalf. As an authorized user of this credit card I will not dispute the payments with my credit card company; so long as the transactions correspond with the terms indicated on my previously signed paperwork.

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.

I am aware that some charges could be made in international currency and that foreign purchase fees from credit card companies may apply.

I assume all risk and responsibilities associated with using debit cards for my payments.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

January 1, 2023 10:07 pm CST

Credit Card Authorization Uploaded by Katie Hartman - forms@kalikosmos.com IP 172.56.91.126

Travel Leaders/KaliKosmos Travel Credit Card Authorization

Travel Leaders/KaliKosmos Travel
Credit Card Authorization