|
I, , am a client of KTA, Inc.
d/b/a Brazos Country Travel.
I hereby appoint the owner, manager, and employees of Brazos Country Travel to be my attorneys-in-fact
for the purpose of signing any documents necessary to purchase and issue airline tickets and/or other travel
documents for the following passenger(s):
Passenger #1:
Date of Birth:
Passenger #2:
Date of Birth:
Passenger #3:
Date of Birth:
Passenger #4:
Date of Birth:
Passenger #5:
Date of Birth:
Passenger #6:
Date of Birth:
I hereby authorize any of my attorneys-in-fact to sign for credit card charges on my behalf, and I intend such
signature to bind me the same as if I had personally signed for the purchase. I agree that I will pay for
all such purchases and will not hold Brazos Country Travel responsible for any of its actions pursuant to
this limited power of attorney.
I authorize you to charge $
to my
credit card # ,
expiration date ,
security code .
Cardholder Name:
Phone:
Billing Address:
City/St/Zip:
E-Mail:
NOTE: Please be aware that after you have made your initial trip deposit, any change or cancellation
will result in penalties and/or fees assessed by both the travel supplier(s) and Brazos Country Travel.
WE STRONGLY RECOMMEND THE PURCHASE OF TRIP CANCELLATION INSURANCE.
I do
do not want to purchase Trip Cancellation Insurance.
So we can find you the lowest priced Trip Cancellation Insurance, list all passenger dates of birth above.
Signature:
Date Signed:
Type your name in the Signature box, thus indicating your acceptance of all terms and conditions in this
Limited Power of Attorney as if you had signed the document.
|
