Credit Card Purchase Authorization

Your completion of this authorization form helps us protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential.

Because of new credit card security procedures, do not include your cvc# or 3 digit security code on this form. This must be e-mailed separately to your agent.

(Please note that this may delay issuing your tickets, no fare is guaranteed until ticketed.)

Credit Card Information

* Card Holder Name:

Cardholder Phone:

* Credit Card Type:

* Credit Card Number:

CVC# must be e-mailed separately to agent

* Card Expiration Month:

* Card Expiration Year:

* Card Billing Address:

* Card Billing City:

* Card Billing State:

* Card Billing Zip:

Traveler Purchase Information

Organization Name:

Organization State:

Please List Each Passenger You Are Authorizing For Purchase

Passenger List:

Selling Fare to your client: ( With out taxes & shipping ) Taxes and Fees

Adult: Taxes: (Per Person)

Child: Shipping: CX accepts credit cards but the published fare will be charged to the card and your commission check will be mailed with in 10 business days.

Infant: 4% Service Fee: 4% is only for AA/SN / BA / AF

Total Authorized Charges:

Agency Name:

Agent Name:

Agency Phone#:

* Email Address:

* Signature (type your name as signature): Date: