1327 Empire Central Drive, Suite 260
DALLAS, TEXAS 75247 USA. 214-310-1411
Note: Please email us a scanned copy of your Credit Card (front and back), and a copy of the Card holder's Passport or State ID (Driver's license) to email@example.com along with this form.
Passenger's Name: ____________________________________________________________________________
Card Holder's Name: __________________________________________________________________________
Card Expiration Date: _________________________________________________________________________
Total Amount (USD): __________________________________________________________________________
Billing Address: _______________________________________________________________________________
Home Phone / Cell: ___________________________________________________________________________
Office Phone: _________________________________________________________________________________
In lieu of my credit card imprint, I _________________________________________, hereby authorize Skyline Travel Incorporated. and/or their representative to charge my Credit Card for the amount shown above. By signing below, I acknowledge the charges described above. Payment in full to be made when billed or in accordance with the policy of the company issuing the credit card.
Cardholder’s Signature: _______________________________________________________________________
Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud. All information entered on this form will be kept strictly confidential by Skyline Travel Incorporated. Complete and email us a scanned copy of this form to firstname.lastname@example.org.