Manassas Travel

 Credit Card Authorization Form
State of Texas

Please fill out the information below and we will contact you about your travel plans.

Please print this form and fax it back to 
(435) 940-1955 or (801) 281-3567.

CREDIT/CHARGE CARD AUTHORIZATION:

I am a client of Manassas Travel I hereby appoint the owner, manager, and all employees of Manassas Travel, to be my attorneys-in-fact for the purpose of signing and documents necessary to purchase/issue airline tickets and travel related services and to charge these purchases to my corporate and/or personal credit/charge card authorizations on my behalf. I intend such signature to bind me the same as if I had personally signed the purchase of tickets, and/or travel related services, whenever any of them receives a telephone call or fax reasonably believed to be from me, or someone acting on my behalf, requesting that they issue airline tickets and or travel related services for me or anyone else and charge those items to the below identified credit/charge card account(s). I agree that I will pay for all such purchases and will not hold Manassas Travel, Inc., responsible for any of its actions pursuant to this power of attorney. This limited power of attorney shall remain in full force and effect until terminated by me in writing. Such termination to be effective only with the respect to airline tickets and travel related services purchased after the time that the written termination is delivered to Manassas Travel

CREDIT/CHARGE CARD TO BE USED FOR BUSINESS TRAVEL:

Your Name

 Email Address:
Card Type:

 Expiration Date:
Account Number:

 Name as it appears on the card:

Company Name:

 Phone # of Card Holder:

I HAVE INDICATED BELOW THE CREDIT/CHARGE CARD THAT I WOULD LIKE TO USE FOR THE GUARANTEE OF HOTEL AND CAR RESERVATIONS, IF DIFFERENT THAN WHAT I HAVE INDICATED ABOVE:

Card Type:

 Expiration Date:
Account Number:

 Name as it appears on the card:

FOR PERSONAL/LEISURE TRAVEL PLEASE USE THE FOLLOWING CREDIT/CHARGE CARD:

Card Type:

 Expiration Date:
Account Number:

 Name as it appears on the card:

Check this box if you have read and accepted this agreement.

If you are faxing in this form please fill out the following below:

_________________________________________________
Signature of Card Credit Holder:

_________________________________________________
Printed Name:

_________________________________________________
Date:

Witnessed By:

_________________________________________________
Signature:

_________________________________________________
Printed Name:

_________________________________________________
Date:

Please print this form and fax it back to 
(435) 940-1955 or (801) 281-3567.

© 2001 Manassas Travel