EFTA00313728.pdf

Aarnott. HOTELS & RESORTS Credit Card Authorization Form Dear Sir Ni44:1111, This form has been created in order to allow you to have third party expenses charged to your credit/debit card. Please provide all the information requested below to ensure prompt processing of your application. We ask you to please sign and date the form before submission. Please fax the completed form to 340at 7156193 Cardholder Information - Required Name as it appears on the creduldebit card: -a —a Ffsg_cj /..) Card type: O Visa O MC a .-Amex O Dinets/CB O Discover O JCB Account type: O/Personal El Corporate i Company Name: Issuing Bank: C Phone #: Account number. Exp. Date: Address: Salami es ratios A I q EAST Ai . 1St s'- City. State and Zip: \ Phone number Fax or alternate number: guest Information -Required Guest name: Address: City, State and Zip: Company: Phone number: Fax or alternate number. Confirmation number. II?(el Arrival date: PAN 1± Departure date: MM =D.+ es).0 Relation to cardholder O Relative O Friend a —Business Associate O Other: I ursdermand that should there be any issues with the aeditidebit card being used to settle my charges. I will be responsible for all expenses incurred during my gay. Departure date cannot be extended unless a new authorization form is completed. Guest MUM: lawen Guest signature: Date: Rate Information and Approved Charles - Required Room rate:• l+ii, Taxes:• TOW daily rate:* Number of nights: 1 -- •(Rate and tax amount must be provided by a hotel representative in order to complete this form) la -All Charges p Room & Tax O Telephone (LD) O Telephone (Local) O Restaurant ❑ Room Service O Valet (Laundry) O Parking O HS Internet Access O Movies ❑ Other I certify that all information is complete and accurate. I hereby authorize Frenchman's Reef & Morning Star Marriott Beach Resort to ailed payment for all charges at indicated in the Rate Information and Approved Charges section of this form by processing a charge to the credit/debit card listed above. Charges must not exceed for the entire staylevent I understand that a new form will have to he completed If pest wishes to extend his/her stay. I certify that I am the authorized signer of the crodiudebit card listed above. Cardholder name: Wrmeei Cardholder signature. Date: MAI DOI4 1.•••••••• • • EFTA00313728