| I, , holder of credit card number , with |
| expiration date on , address |
| , phone |
| number , and of the driver license number |
| with expiration date on , authorize (Name |
| of the travel agency) to charge my credit card mentioned above, the amount |
| USD$ for . (Name of the passengers) to travel |
| |
| (Itinerary) departing on . |
|
Signature Date
Hereby authorize my travel agent to verify the above information |