This form has been created in order to allow you to charge to your credit card for a travel booking that has been made by Travel Center Danville.
Please provide all the information requested below to ensure prompt processing of your payment.
I certify that all information is complete and accurate. I hereby authorize Travel Center Danville to collect payment for all charges as indicated above on this
form by processing a charge to the credit card listed above. Charges must not exceed the amount listed above. I understand that a new form will have to be completed
if another payment needs to be made. I certify that I am the authorized signer of the credit card.