Altair CC Authorization Form

Altair International Travel Company, Inc.

**dba Altair Travel & Cruises**
**Credit Card Authorization Form**

Please complete the form below and fax, email, or mail to your travel agent.
Reservation Information/Description of Charges
Lead Passenger Name *
Additional Passenger Names
Travel Agent Name *
Date of Travel *

Month Day Year
Destination *
Description of Charges Authorized:
Description * $Amount*
Description $Amount
Description $Amount
Total Amount Authorized
Credit Card Information
Cardholder Name *
Cardholder Email *
example@example.com
Cardholder Phone *
Card Holder Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Credit Card Type

Mastercard Visa American Express Discover
Last 4 digits of card number. (For security reasons, please do not list full number)
I, First Name* Last Name*, do hereby authorize Altair Travel International Inc. (dba Altair Travel & Cruises) to charge my credit card for the amount of $ Amount to be charged* .
Cardholder Signature *

Clear
Today's Date *

Month Day Year
Altair Travel & Cruises | 2025 S. Brentwood Blvd. | St. Louis, MO 63144

Phone 314.968.9600 | Fax 314.968.8980
Should be Empty:

Altair International Travel Company, Inc.