EFTA00313800.pdf

II] DORAL INN & SUITES Third Party Credit Card Authorization Form This form has been created in order to allow you to have third party expenses charged to your credit/debit card. required to accept this form and the guest should check I understand that the hotel is not with the hotel to ensure they accept third part information requested below to ensure prompt process transactions. Please provide all the ing of your application. We ask you to please sign and Please fax the completed form to Doral Inn and Suites date the form before submission. Miami Airport West at (305) 429 8754 FOR SECURITY reasons. Doral Inn and Suites conform s to all Payment Card Industry (PCI) standards. credit card holder purchase a gift card for the guest (if However, we recommend that the possible) rather than send their credit card number via this third party form. CARDHOLDER INFORMATION - Required Name as it appears on the credit/debit card: JER-ciac-s•I G €---, ps-rel,.1 Card Type: El Visa El MC laikmex 0 Diners/CB 0 Discover 0 JCS Account Type: - 0 Debit / 0 Credit 0 Corporate - Company Name: Issuing Bank: C-;i24CA Phone: Account Number: Address (statement): Exp. Date: gal City, State, Zip: Phone Number. Fax or Alternate Numbe GUEST INFORMATION - Guest Name: Address: City, State, Zip: Company: Phone Number: Fax or Alternate Number: Confirmation Number: Arrival Date: TAr.1 3, a5::)11 Departure Date: Tpvti . apt& Relation to Cardholder: 0 Relative agend 0 Business Associate 0 Other understand that should there be any issues with the credit/debit card being used to settle my charges. I will be responsible for all expens during my stay. Departure date cannot be extended unless a new authorization form is completed. es incurred Guest Name: (Printed) Guest Signature: Date: RATE INFORMATION AND APPROVED CHARGES - Required Room Rate:* tc,S) , as Taxes:* Total Daily Rate:* Number of Nights: *(Rate and tax amount must be provided by a hotel represe ntative in order to complete this form.) ErAll Charges 0 Room & Tax ❑ Telephone (LD) 0 Telephone (Local) ID Restaurant 0 Room Service 0 Valet/Laundry 0 Parking El HS Internet Access 0 Movies 0 Other I certify that all information is complete and accurate. I hereby authorize Doral Inn and Suites Miami Airport West as indicated in the Rate Information and Approved Charge to collect payment for all charges s section of this form by processing a charge to the credit/d must not exceed $5,000 for the entire stay/event. I underst ebit card listed above. Charges and that a new form will have to be completed if guest certify that I am the authorized signer of the credit/debit wishes to extend his/her stay. I card listed above. Cardholder Name: (Printed) r -P-6 GPSTFirJ Cardholder Signature: r Date: SSAdaaae_ Please do no s nd a photocopy of the front or back of your credit 1212 NW 82" Avenue. Miami FL 331261P : (305) 629 8755 / FAX (305) card. 629 8754 / MAW docalmnandsuites.com /email: cloralinneolsolesegmailc an EFTA00313800