EFTA00317361.pdf

THE MARK CREDIT CARD BILLING AUTHORIZATION FORM GROUP GUEST INFORMATION COMPANY/GROUP NAME: CONTACT NAME: INDIVIDUAL GUEST INFORMATION GUEST Datil DEPARTURE DATES !V MAY a 0/5 )\-1A`f , DID CHARGES TO BE BILLED (please indicate by marking an X in the appropriate boxes below) jag). CHARGES (1 CATERING AND MEETING CHARGES () GUEST ROOMS &TAXES GRP ROOM DEPOSITS: AMOUNT S GUEST nsicorakrrms n CATERING DEPOSITS: AMOUNT S OTHER (Desaiption): PLEASE NOTE THAT UPON RECEIPT OF THIS FORM THE CREDIT CARD WILL BE CHARGED FOR THE FULL AMOUNT OF ROOM AND TAX. IP YOU OPT TO COVER ALL CHARGES, THE INCIDENTAL CHARGES WILL BE SETTLED UPON CHECKOUT OP THE GUEST. CARD HOLDER INFO CARD NUMBER: EXPIRATION DATE: gl/ NAME AS IT APPEARS ON CARD: jerpas\I G. GPs-re i)--1 CARD BILLING ADDRESS: EAST Sit CITY: srA • 0 001 TELEPHONE: PAX: EMAIL: AMERICAN EXPRESS VISA () MASTER CARD DINERS CLUB DISCOVER JCB I HEREBY AUTHORIZE THE MARK HOTEL TO USE THE CREDIT CARD INFO TION PROVIDED ON THIS FORM ETHER AS PAYMENT FOR THE CHARGES DESCRIBED ABOVE I AM AWARE SUPPORTING N WILL ACCOMPANY ALL CHARGES. DESIGNING BELOW I AGREE TO PAY MY CREDIT CARD ISSUER POR THE CHARGES AGREED XBOVE IN ACCORDANCE WTTH MY CARDHOLDER AGREEMENT. CARD HOLDER'S SIG DATE SIGNED: M A•1 &D (c- PLEAS ATTACH:1) OCOPY OF PROOF OF IDENTIFICATION 2) FRONT AND BACK O&TFI B CREDIT CARD YOU WISH TO CHARGE 25 East n th Street, New York NY 10075, USA Tel Fax Toll free reservations: EFTA00317361