Alpha Travel Agency CREDIT CARD AUTHORIZATION

ALPHA TRAVEL AGENCY
525 MAIN ST
WORCESTER, MA
508-753-2242


CREDIT CARD AUTHORIZATION

I, _____________________________________ (PRINT NAME AS SHOWN ON CREDIT CARD) HEREBY AUTHORIZES __________________________________________ (ISSUING AGENT) AT ALPHA TRAVEL AGENCY TO CHARGE MY ________________________________________________ (TYPE OF CREDIT CARD, NUMBER, AND EXPIRATION DATE) FOR THE AMOUNT OF $_______________ IN PAYMENT OF TRAVEL ARRAGEMENTS FOR MYSELF AND OR/ ________________________ (PASSENGER (S) NAME)

MY BILLING ADDRESS IS: ____________________________________

PHONE NUMBER IS (H) _____________________(B) _______________

SIGNATURE: ______________________ DATE:__________________


NOTE: IDENTIFICATION IS REQUIRED. PLEASE PROVIDE A PHOTO COPY OF THE CREDIT CARD FRONT/BACK.