Credit Card Authorization Form
Travel Agency Name
Cardholder Name (as appears on card)
Billing Address
City
State/Province
Zip/Postal Code
Country
Email Address
Phone Number
Name of Traveler(s)
Trip Details/Destination
Total Amount to be Charged (USD)
Credit Card Number
Expiration Date
CVV
Additional Notes / Authorized Charges
Cardholder Signature
Date