Print out and fax to: 1-415-371-8084

CREDIT CARD AUTHORIZATION

In lieu of my credit card imprint (name as it appears on credit card):

Name: ________________________________________

HEREBY AUTHORIZE PALMAIR TRAVEL OR IT'S AGENT TO CHARGE MY:
(AX, VI, MC, .............

*ACCOUNT #: ______________________________
EXP. __________

CREDIT CARD CUSTOMER SERVICE (800 #):         1-800-___________________

*IN THE AMOUNT OF: $            .        FOR MY PAYMENT TRANSACTION.

*FOR MYSELF AND (PASSENGER NAMES):

1. ________________________________________ 2. _____________________________________

3. ________________________________________ 4. _____________________________________

*MY HOME TELEPHONE # IS: ___________________________________

*MY WORK TELEPHONE # IS: ___________________________________

*ADDRESS WHERE CREDIT CARD STATEMENT IS RECEIVED:

STREET _____________________________ APT# (OR SUITE) _____________

CITY _________________________________STATE ________ ZIP CODE ______________

*ADDRESS WHERE TICKET IS TO BE MAILED:

STREET _____________________________ APT# (OR SUITE) _____________

CITY _________________________________STATE ________ ZIP CODE ______________

BY SIGNING BELOW, I ACKNOWLEDGE CHARGE DESCRIBED HERON. PAYMENT IN FULL TO BE MADE WHEN BILLED OR EXTENDED PAYMENT IN ACCORDANCE WITH STANDARD POLICY OF THE COMPANY ISSUING THE CARD.

SIGNATURE: X_________________________________________

*THIS FORM MUST BE TRANSMITTED TO PALMAIR TRAVEL, FAX 415-371-8084, PRIOR TO TICKET ISSUANCE. INCOMPLETE OR FALSE INFORMATION SHALL BE CONSIDERED SUFFICIENT CAUSE FOR DENIAL OF TICKET.


(VERY IMPORTANT) PLEASE MAKE COPIES OF CREDIT CARD FRONT AND BACK WITH A
COPY OF CARD HOLDER'S DRIVER'S LICENSE AND TRANSMIT ALONG WITH THIS FORM.