Credit Card Authorization Form
Booking Information
Booking Number
A
Reservation Agent Name
Agency Information
Travel Agency Name
ARC / IATA
Street Address 1
Street Address 2
City
State / Province
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ME
MH
MD
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MS
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NE
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MP
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OK
OR
PW
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AA
AE
AP
AB
BC
MB
NB
NF
NT
NS
ON
PE
QC
SK
YT
ON
Zip / Postal Code
Country
-- Select --
USA
Canada
Telephone
Traveler & Payment Information
Traveler Names (one per line)
Email
Amount (USD)
$
First Name on Card
Last Name on Card
Billing Address (must match card)
City
State
-- Select --
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
AA
AE
AP
AB
BC
MB
NB
NF
NT
NS
ON
PE
QC
SK
YT
Zip
Country
-- Select --
USA
Canada
Telephone
I authorize SITA World Tours to charge the indicated amount to my credit card...
I have read and agree to the
Terms and Conditions
I certify that I am the cardholder and a traveling passenger. This is my electronic signature.
Cardholder's Name (Electronic Signature)
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