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:

Signature arrow

Signature Certificate
Document name: Credit Card Authorization
lock iconUnique Document ID: 496d9c5569a81e2c3f2c41ad297e58fea7caa77c
Timestamp Audit
November 21, 2020 8:34 pm CSTCredit Card Authorization Uploaded by Julie Grauf - julie@kalikosmos.com IP 24.253.247.44
November 21, 2020 8:47 pm CST Document owner forms@kalikosmos.com has handed over this document to julie@kalikosmos.com 2020-11-21 20:47:30 - 24.253.247.44