CREDIT CARDHOLDER'S AUTHORIZATION
Please print form, complete and return to Pilgrim Tours, PO Box 268, Morgantown, PA, 19543
or Fax to Pilgrim Tours at 610 286 6262

Attention Pilgrim Agent:_____________________________________________________________

Destination or Tour name: _{______________________________________________________________________}

Date(s) of Travel: _{_________________________________________________________________________________}

In lieu of my Credit Card Imprint, I ____________________________________________ hereby authorize Pilgrim Tours
                                                        (PRINT NAME OF CARDHOLDER AS SHOWN ON CREDIT CARD)
    
To charge my:                    z  Mastercard                                 z  Visa                     

Credit Card Number___________________________________  Security Code (3 digits, back of card)____________
Exp. Date: ________________________ 

In the Amount of: $ _________________________________  for payment of travel arrangement for myself and/or

Full Name of Passenger if other than Cardholder: ___________________________________________________

Card Billing Address: __________________________________ City: ____________ State: _____  Zip: _________

Phone No:_____________________________________ Fax No.: _____________________________________

Email: _____________________________________________________________________________________

You must  provide a legible copy of this credit card, front and back, and a copy of either a photo drivers license 
or current passport to verify identity. 

Signature below indicates acknowledgement of charges described hereon. Payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing credit card.


____________________________________________________________________________________________
Cardholder's Signature                                                                                                                       Required Date