This authorization form must be completed by the credit card holder and faxed along with a copy of proof of your identification (ie: drivers license, passport, utility bill.) If a third party is charging your trip, a photo copy of the credit card is also required. Please print, complete and fax to 240-248-7567. This is for the consumer's protection.

I, ______________________________________, authorize Connie George Travel

Associates to submit my charge in the amount of $________ to:

___________________________(supplier) for travel to: _____________________

(destination) on ___ /___ /___ - ___ /___/___ for the these travelers:

_____________________________________________________________________.

Account Number: ___________________________________

Cardholder: ________________________________

Expiration Date:___/___

Credit Card Billing Address: __________________________________________________________________

Signature: ____________________________________

Date: ____________________

Agent handling vacation: ____________________