Credit Card Authorization - Starlight International Travel

Credit Card Authorization Form

Please complete this form to authorize Starlight International Travel to charge your credit card for the specified amount. All information is securely encrypted and stored.

Authorization Form

Cardholder Information

Cardholder Name*

Email*

Phone*

Billing Address

Street Address*

City*

State*

ZIP Code*

Country*

Credit Card Information

Card Type*

Visa

Mastercard

Amex

Discover

Card Number*

CVV*

Expiry Month*

Expiry Year*

Authorization Details

Amount to be Charged (CAD)*

Authorization Date*

Purpose of Charge

Authorization Statement

By signing below, I authorize Starlight International Travel to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the amount indicated above only, and is valid for one time use only for the date indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Signature*

I confirm that all information provided is accurate and I authorize this transaction*

Security Notice

All credit card information is transmitted securely using SSL encryption and stored with industry-standard security measures. Your card information will only be used for the authorized amount and purpose specified in this form.

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