Kosmos Travel Credit Card Authorization Form

I hereby authorize Kosmos Travel, Inc, acting on behalf of airlines/tours/cruises companies to charge my credit card for payments of all transportations, accommodations, visas and other services included in the package.

Credit Card Type *:
Credit Card No:
Expiration Date:
CVV (Card Verification Value) *(4 digits for AMEX just above the number)
(3 digits for others on the back of the card):
Amount *:
Issuing Bank’s Name:
Credit Card Billing Address *
Phone Number:
Full name(s) of passenger(s) traveling as it(they) appears(appear) in his/her/their passport(s) *
By signing below, I acknowledge the charge described hereon and I am aware of applicable restrictions and/or penalties it might have. Payment in full to be made when billed or in extended payments in accordance with standard policy of credit card issuing company. I also declare that I am aware that many tickets/services are non-refundable and transferable.
Please sign/print your name *