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:

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Document name: Credit Card Authorization Form
lock iconUnique Document ID: 99140f810608435a06af36f8663a0d0dff75a611
Timestamp Audit
January 16, 2021 11:31 am CSTCredit Card Authorization Form Uploaded by Julie Grauf - julie@kalikosmos.com IP 24.253.247.44
January 16, 2021 11:33 am CST Document owner forms@kalikosmos.com has handed over this document to julie@kalikosmos.com 2021-01-16 11:33:11 - 24.253.247.44