KaliKosmos Travel

Credit Card Authorization Form


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 Form
lock iconUnique Document ID: e932b64dcdf8e5fccbdac0364193611d8e5655c8
Timestamp Audit
January 16, 2021 11:31 am CDTCredit Card Authorization Form Uploaded by Julie Grauf - julie@kalikosmos.com IP 172.58.56.71
January 16, 2021 11:33 am CDT Document owner forms@kalikosmos.com has handed over this document to julie@kalikosmos.com 2021-01-16 11:33:11 - 24.253.247.44