
Atlanta
International Travel Inc.
7050 Jimmy Carter Boulevard Suite 202 Norcross GA 30092 United States of America
Phone: 770-449-7272 Fax: 770-449-0567
Credit Card #:__________________________________________ Exp Date:_______________
Issuing Bank:____________________________________ and Phone No:_________________
CC Holder Name:_______________________________________________________________
CC Billing Address:_____________________________________________________________
__________________________________________________________________
__________________________________________________________________
Phone No: (Res)_____________________________(Work)_____________________________
Name of Passenger (s):___________________________________________________________
Authorized charge amount in USD $:_______________________________________________
Confirmation Signature:__________________________________________________________
I give full authorization to Atlanta International Travel _______________________________ (Travel Agent) And ________________________________________ (Airline) to charge the above mentioned amount charged on my credit card as identified above and shall not decline, reject or challenge such amount charged on my credit card for the purpose of paying for air tickets for the passengers identified above. I also declare that I’m aware that some restrictions may apply to the tickets purchased by this transaction and that I am satisfied that such restrictions have been explained to me.
Card Holder’s Signature:_________________________________________________________
Signed at (City)__________________________________on (Date)_______________________
PLAEASE ATTACH
PHOTOCOPY OF CREDIT CARD (FRONT AND BACK)
AND DRIVER’S
LICENCE.
PHOTOCOPIES MUST
BE LEGIBLE FOR ACCEPTANCE. NO
EXCEPTIONS