Credit Card Authorization

Travel Leaders/KaliKosmos Travel
Credit Card Authorization

Card Holder Name:  
 Street Address:  
City:   State:   Zip:  


 Card Number:  
Exp:   Security Code:  


Upload a copy of the front of the card holder's ID


Upload a copy of the front of the card


Upload a copy of the back of the card


I authorize KaliKosmos Travel independently contracted with Leone Travel d.b.a Travel Leaders ("The Agency")  to use this information to make payments directly to travel service suppliers on my behalf. As an authorized user of this credit card I will not dispute the payments with my credit card company; so long as the transactions correspond with the terms indicated on my previously signed paperwork.  

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.

I am aware that some charges could be made in international currency and that foreign purchase fees from credit card companies may apply.

I assume all risk and responsibilities associated with using debit cards for my payments.

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Signature Certificate
Document name: Credit Card Authorization
lock iconUnique Document ID: 4c988d35e41650eb6c60bf8dd2472ec16d44ad2e
Timestamp Audit
January 1, 2023 10:07 pm CDTCredit Card Authorization Uploaded by Katie Hartman - IP