Airline Credit Card Authorization Form Sample



AIRLINE CREDIT CARD AUTHORIZATION SAMPLEPLEASE ATTACH THE FOLLOWING ITEMS:This Credit Card Authorization Form;Photocopy of Credit Card (both sides); andPhotocopy of Driver’s License or Passport Picture (signature page)Airline Reference Code (if any): 64CZYX (6 digits)NAMES OF ALL TRAVELERS USING THIS CARD:NAME: Jonathan Smith AGE: 33 DOB: 12/25/1986NAME: Kyle Smith AGE: 10 DOB: 01/12/2010CARD TYPE:? VISA ? MASTERCARD ? AMERICAN EXPRESS ? DISCOVER ? OTHER: ___________________________Cardholder’s Name: Jason RobertsonCard Number: 4453-5567-8790-1110CVC Number: 789 (3 or 4 digits on the back)Expiration Date: 01/2023BILLING ADDRESS (where you receive statements):123 Appleville RdCapertown, California13256Cardholder’s Phone: (312) 555-6767I hereby authorize Delta Airlines and its suppliers and/or designees to charge my card in the amount of $1,312.97 for the payment of tickets for the above-mentioned travelers and agree to the terms and conditions of said payment.111760099385CARDHOLDER’S SIGNATURE2032069215___________________________ DATE: January 14th, 2020Print NameJason Robertson ................
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