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.
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