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: c82abd83a868bccfb07914792be9d6b3483dac3e
Timestamp Audit
November 21, 2020 8:34 pm CDTCredit Card Authorization Uploaded by Julie Grauf - julie@kalikosmos.com IP
November 21, 2020 8:47 pm CDT Document owner forms@kalikosmos.com has handed over this document to julie@kalikosmos.com 2020-11-21 20:47:30 -