_____________________________________________
        (name of cardholder as shown on credit card)

hereby authorize Future Travel, Inc. on behalf of,

_____________________________________________
            (issuing carrier/wholesaler name)

to charge my

________________________________________________________________________________________________
      (credit card name)           (credit card no.)                                    (security code on back)      (expiration date)

in the amount of $ _______________ for payment of services for myself and/or
                                      (total amount)

______________________________________________ for travel to___________________
(full name(s) of passenger(s) if other than cardholder)                                   (destination)

departing on _______________________
                                      (date of travel)

My billing address:___________________________________________________________

My home address:___________________________________________________________
                                              (street address)

                                   
Home Phone: ________________________

Office Phone: _______________________