University Travel Credit Card Authorization Form
1888 Eucalyptus Road
(800) 821-5094 ext. 201 or (818) 563-9235
CST registration # 1015591-40
This is to authorize payment to University Travel by credit card. Your credit card will not be automatically charged, but will be charged at the University Travel office once the form is received.
You may send this information to us electronically by using the "submit" button below, or print it and FAX it to us at:
Credit Card Billing Street address, Line 1
Credit Card Street Billing Address, Line 2
City, State, Zip Code
Invoice Number (if available):
Secure Credit Card Information: (Please note - your card is not charged upon submission - we will charge it at the University Travel office).
Name on Card
Credit Card Type
Credit Card Number
Expiration Date (mm/yy)
3 or 4 digit security code:
Payment Amount Authorized:
Thank you! This authorizes University Travel to charge the above amount for travel services. You will receive an acknowlegment e-mail.