Brazos Country Travel - Return to the Main Page

Brazos Country Travel

Limited Power of Attorney
To Purchase Travel

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.   

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.