Low Ticket.Com / Ameristar Travel
Credit Card Authorization Form

Passenger Information

Passenger Name:

Departure date:

Total charge per person:

Total amount billed:

Credit Card holder name:

Billing address:

City:

State:

Zip:

Billing phone number:

Credit Card type:

__ Visa     __ MasterCard __ Discover Card __ Other

Credit Card number:

Expiration date:

                                             CVS 

International Travelers   (Vendors Require)

Name as it appears on Passport:

Passport number:

Expires:

Country that issued Passport:

Birth Date:

Country of citizenship:

Emergency contact name:

Emergency contact phone:

I understand that this purchase may be Non-Refundable as per the Airline/Vendor rules. Please review Cancellation Policy before purchase! 

The Vendor may require a faxed copy of the front and back of your
 drivers license. Do Not fax unless we request at time of booking.

I hereby authorize Low Ticket / Ameristar Travel to charge the total amount listed above to my credit card described above. 

Authorized Signature:

X

Date:

FAX # - 817-284-2098