EFTA00314042.pdf

CREDIT CARD AUTHORIZATION FORM Hotel- alHyatt Regency- Individual/Business/Group or Event Nam*: Reservation Confirmation Number: MI Arrival or Event (Weis): Credit Card Billing Address: 9 East 71st Street City / Stater Zip 1Countryi Region New Yorke NY 10021, USA : Contact Phone Number: Contact Email Address: • A valid telephone number and email are required we as will need to contact you to confum receipt. If we ore unable to do so, your reservation will be subject to cancellation. I hereby authorize the following charges to be applied to the following credit card. Check all that apply: j Room & All Applicable Taxes C GIh Certificate El All Stay Charges ❑ Food & Beverage CI Only SpectfK Incidentals ❑ All Banquet Charges ❑ Guest Amenity C All Incidentals D Resort Services Fee C Parking r: Other see comments hereby authorize the following amoun t be applied to the credit card (applicable sales tax and service charges may apply): sac •In Australia: An additional service fee will apply to the total stay account when paying by AMEX, Diners and oil upon departure (excluding Park Hyatt Sydney). Refer to other credit cords the hoters webute for more details. Comments: • The credit card listed below may be billed for the estimated charges Ten (701 days prior to iwenterservet • Room and tax on individual bookings will be charged iondate. 72 hours in advance. Credit Card Number. Name on Card: Jeffrey Epstein Expiration Date: Cardholder Phone Is: I Signature of Card Holder kc anutagemgc/ ____ Current Date: 5/18(19 • Hotel reserves the right to refuse a credit card od payment for same day bookings or authorization received on day of arrival. 11 geeing SySubmitting this form and any supposing. . you In atccedance with row GSOtwl Pr rs I tonfnm that. Nye read and agreed to rne v>e d the persona 'icy for Gaut whichisavailablea prnaKyhyatt corn l Information I am Please fax this completed form to: Hotel Fax e: L For a Nit of all hotels and thrir contact infra motion . ;weave visit hrosilweise nyall.COrnihyatt1SitemaP ISO All information Is kept confidential end used only for the purposes as noted above ut411 li e a o Pas acfleVal. ire ate WYATT HYATT ANda crac i ) 14 /4 EFTA00314042