KaliKosmos Travel

Credit Card Authorization Form

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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Document name: Credit Card Authorization Form
lock iconUnique Document ID: b69d9cb6f754c71557f895aadf23bc1b79824525
Timestamp Audit
January 16, 2021 11:31 am CSTCredit Card Authorization Form Uploaded by Julie Grauf - julie@kalikosmos.com IP
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 -