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Credit Card Authorization: |
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Confirmation Number |
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In lieu of my credit card imprint, I (card holder) |
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Hereby authorize agency to charge my (credit card name) |
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Credit card number |
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- (expiration date) |
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- (credit card 800 number) |
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In the amount of $ |
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For that payment of transportation of myself and/or
(name of passenger(s)) if other than card holder |
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For my itinerary as follows: (trip routing) |
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Billing address of the credit card |
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Phone
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(H) |
(W) |
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Signature of Cardholder
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