1140 Empire Central Drive,
Suite 350, Dallas, TX 75247
Ph. : (214) 631 2458
Fax : (214) 631 2464
AUTHORIZATION TO CHARGE ON CREDIT CARD
Note: Please fax
a photocopy of your Credit Card (front and back), and a
photocopy of the card holder's Passport or State ID (Driver's license) to (214)
631-2464 along with this form.
Master Card
Visa
American Express
Discover
Passenger Name:
Card Holder Name:
Card Number:
Card Expiration Date:
Total Amount (in US Dollars):
Billing Address:
Billing City:
Billing State:
Billing Country:
Billing Zip:
Home Phone:
Office Phone:
Fax Number:
In lieu of my credit card imprint, I ,
hereby authorize Lawson Travel, Inc. and/or their
representative to charge my Credit Card for the amount shown
above. By signing below, I acknowledge the charges described
above. Payment in full to be made when billed or in
accordance with the policy of the company issuing the credit
card.
