Valmon Travel - Credit Card Authorization Form

Credit Card Authorization Form

Passenger Names:

_______________________________________________________

Booking #:

_______________________

Departure Date:

_______________________

I, ___________________________________, hereby authorize Valmon Travel Int'l/ Vendor/ Airline Carrier to charge against my credit card account listed below:

Credit Card:

Visa MasterCard Amex Discover

Amount to be charged:

_______________________
for: Deposit Airfare Final Payment

Credit Card #:

____________________________________ CID#: ___________

Exp. Date:

____	____	______
MM	DD	YYYY

Card Holder Name:

_____________________________________
Please Print as it appears on card

Card Holder's Billing Address:

_____________________________________
Billing Address
_____________________________________
City
_____ __________
State Zip Code

Home Phone

_____________________________________

Work Phone:

_____________________________________

E-mail Address:

_____________________________________

Signature:

______________________________________ Date: _____________

The cardholder's information must be complete in order to insure prompt processing of your reservation.

Please print this form, fill out and fax it to 201-836-8826.