Ken's Travel Trove
Credit Card Authorization Form
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Independent Travel Advisor
PIN
Advisor Phone Number
-
Area Code
Phone Number
Card Number
*
CVC
*
Amount to be charged
*
Card Type
VISA
MASTERCARD
DISCOVER
AMERICAN EXPRESS
Expiration Date
*
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Date of Departure
-
Month
-
Day
Year
Date
Date of Return
-
Month
-
Day
Year
Date
I authorize Ken's Travel Trove to charge my credit card for the authorized amount. I understand that my information will be saved to file future transaction on my account.
*
Yes
No
Cardholder Signature
*
Date of Signature
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: