Rose Travel and Tours Credit Card Authorization Form 
Fax completed form to one of the numbers below

CREDIT CARD INFORMATION

Name:  ___________________________________________________________ (as shown on CREDIT CARD)

Credit Card No: 

Exp Date:             CCV  ________

Billing Address:  ________________________________________________________________________________________________

Card Holder's Home Phone:_______________________  Credit Card Customer Service # ____________________________

BOOKING INFORMATION

SABRE                                               Airline

Record Locator:    ______________                       Confirmation #  : __________________________________

(Filled by Travel Agent)                                        (Can be filled by Passenger if not sure Leave Blank)

NAMES OF ALL PASSENGERS TRAVELING USING THIS CREDIT CARD:

1) ________________________               Charge Amount per Adult________  Child ________   Infant ________

    (Last Name)                     (First Name)

2) ________________________               Charge Amount per Adult________  Child ________   Infant ________

    (Last Name)                     (First Name)

3) ________________________               Charge Amount per Adult________  Child ________   Infant ________

    (Last Name)                     (First Name)

4) ________________________              Charge Amount per Adult________  Child ________   Infant ________

    (Last Name)                     (First Name)

I hereby authorize Rose Travel and Tours in the behalf of the Consolidator ________to charge

my card in the amount of $___________for payment of tickets for all the above passengers.

___________________________________________                                 

(SIGNATURE OF CARD HOLDER MUST BE SAME AS SHOWN ON CARD)