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I authorize UNIVERSAL TOURS to charge my (CIRCLE ONE)
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Credit Card Number: ________________________________________________________________
Expiration Date: ____________/_____________
(Month) (Year)
In the amount of $ ____________________ for the purpose of: _______________________________
Name on Card: ___________________________________________________ Sex: Male / Female
Credit Card Billing Address: ________________________________________________ Apt#_______
City: _____________________________________ State: _____________________ Zip___________
Home Phone: (_____)______________________ Work Phone: (_____)_________________________
(FOR SECURITY PURPOSES DOCUMENTS WILL BE MAILED TO BILLING ADDRESS OF CLIENT)
Email: _________________________________________________________________ (optional)
Passenger Names should be exactly as in passport for international flights or government ID for domestic.
Passenger 1: _________________________________________________ DOB: ________________
Passenger 2: _________________________________________________ DOB: ________________
Passenger 3: _________________________________________________ DOB: ________________
Passenger 4: _________________________________________________ DOB: ________________
This authorization form is in lieu of an imprinted credit card form. I have read Universal Tours terms and conditions and give permission for the above documented amount to be charged. By signing this authorization form I shall under no condition decline, reject, or challenge the amount that has been authorized above.
Signature of Card Holder: _____________________________________________ Date: ___________
Thank You!
We at Universal Tours appreciate your business! |