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Credit Card Authorization Form

Please complete all fields. You may cancel this authorization at any time by contacting MMV. This authorization will remain in effect until canceled.

Credit card Information

Card Type

Card Type
A
B
C
D
E

Cardholder Name (as shown on card)

Card Number

Expiration Date

Cardholder ZIP Code (from credit/debit card billing address)

I,___________, authorize Mountain Memories Vacations to charge my credit/debit card above for agreed upon services. I understand that my information will be saved to file for future transactions on my file.

Signiture

Signature

Date