FAX THIS FORM TO: 404-420-2311
Credit Card Authorization
We will need the following information as authorization to charge your travel arrangements.
Credit Card Authorization: I __________________________________________, authorize __GOLDEN TRAVEL___ to charge my credit card for the amount listed below pertaining to travel arrangements that I have purchased, (___ including travel insurance). I understand that you will verify this information with the credit card company, and I declare that this information is correct.
Reservation for _____________________________________________________________ Reservation number__________________________________________________________ Cardholder's name____________________________________________________________ Billing address_______________________________________________________________ ___________________________________________________________________________ Home telephone__________________________Work telephone_______________________ Email Address:_______________________________________________________________ Please charge the following amount to my credit card account specified below: $________________________[ ] Deposit due _______________ $________________________[ ] Deposit due _______________ $________________________[ Visa [ ] MasterCard [ ] Final payment due___________ ] Other_____________[ ]
] American Express [
Credit Card #______________________________ Expires ___________Security Code_______
Cardholder's signature______________________________________________________ Today's date____________________________Approval code______________________ Please provide a copy of front and back of credit card for verification [ ]