EFTA00313771.pdf

PULLMAN RIGA OW TOWN HOTEL 24 JEKARA STR. LV-1050 RIGA LATVIA +371 67815444 [email protected] PULLMANNOTELS.COM ACCORHOTELS.COM AUTHORISATION TO CHARGE MY CREDIT CARD ACCOUNT Room reservation conformation Nr. Name (as It appears on card): Card type (please check): VISA n Mastercard / Eurocard Maestro 111 Card number: Expiry date: aolP By signing this form, I authorize Hote l Pullman Riga Old Town to charge my credit card account with the following amount: (currency) LA Lt....A eiS (amount) t liOO. 4" for (description of the services purchased; confirmation/invoice number): IQD Dik-4 Date: NOV II Q01 -4-- Place of signing: Signature of cardholder: Completed authorization form should be :d to: [email protected] +371 67815444 Contact erson handl' okings: t -E-7- --?•4-±- AME,c Ce4-nAR.rvt-i Please keep a copy of this form for your own records! EFTA00313771