CC Authorization

One Time Credit Card Payment Authorization Form

Please complete this form to authorize STG Travel Inc to make a one time debit to your credit card listed below.

By completing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

CC Authorization

Agent you are working with *

or description of goods/services

Amount *

Charge on or after Date *

Billing Information

Cardholder Name (as shown on card) *

First

Last *

Last

Billing Address *

Billing Address

Street Address

Apt./Building/Suite #

City

State/Province

Zip/Postal

Country

Credit Card Information

Card Type *

Credit Card Number *

Credit Card Number

Credit Card Information *

Credit Card Number

Expiration Date *

CVV Code *

Authorization *

By checking this box I authorize STG Travel, Inc. to charge the credit card indicated above according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. 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.

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