AMERICAN AIRLINES Credit Card Authorization Form
Sign the authorization, Scan, in PDF Format and send by e-mail to [email protected], or Fax
completed form to (407) 442-0617 please send a confirmation e-mail if delivered by FAX.
Please fax the following items:
(1) This Credit Card Authorization Form
(2) Photocopy of Credit Card (Both Sides) and
(3) Photocopy of US Driver's License OR Passport Picture and Signature Page
*Please include the AA Reservation code:_______________________
*Please read reservations instructions in the second page
NAMES OF ALL TRAVELERS TRAVELING USING THIS CREDIT CARD:
1) _______________________________________ Charge Amount per Adult_$__________________
(Last Name)
(First Name)
2) _______________________________________ Charge Amount per Adult_$__________________
(Last Name)
(First Name)
Fill in CREDIT CARD TYPE
( ) Visa ( ) MasterCard ( ) American Express
( ) Discover Card
Card Holder's Name:_____________________________________________
Credit Card Number:________________________________ (Print Clearly)
CVC Number:________________ (last 3-4 digits of number on back of card)
Expiration Date:_____/_____
Billing address where you receive credit card statements:
_______________________________________________________________________
Card Holder Phone:______________________________
Card Holder Work Phone:________________________ Cell_____________________
I hereby_________________________________________________ authorize American Airlines,
and it’s suppliers to charge my card in the amount of $____________________for payment of
tickets for all the above travelers and I agree to the attached terms & conditions.
CARD HOLDER SIGNATURE: __________________________________________
DATE:_________________________