EFTA00314153.pdf

Gift Certificate Authorization Form This form has been created in order to allow you to have third party expenses SPA THE PENINSULA charged to your credit card. Please provide all the information requested below to ensure prompt processing. We ask that you either fax this completed form to The Peninsula Spa at (212) 903-3958 ore-mail it to GO Card Purchases Recipient (iiiit 1rd/um:rear on the Gift Certifioate): MC t•-• A Psi I e: SP I P-16 I--.1•-• PI% Please Choose ONE of the following options: Services to be Received: Optionsfor Services ONLY: 0 Include Tax on NYC Service Tax) ❑Include Gratuity Please Note: Prices on all Ceremonies. Retreat Packages and Private Spa Suite Services include an 189E gratuity. OR Flat Monetary Amount: Additional Information Special Instructions: Total Value of Gift Card: 43 a 000, 0 0 Delivery Method Please note that we do not ship gift certificates via US Mail. rafidc — Up at Spa Reception No Charge FedEx ❑ Fed Ex Next Day: $35.00 0 Fed Ex Second Day: $14.00 0 Own Fed Ex Account Number. Messenger Manhattan Only Not available on weekends • $15.00 Messenger 9AM — 5PM Weekdays ONLY • $30.00 Messenger After 5PM Wekkdays ONLY Ship to: 0 Recipient 0 Purchaser 0 Third Party Name: Address: City, State and Zip: Cardholder Information Name as it appears on the credit card: Type of Card: 0 Visa 0 Mastercard a -American Express 0 Discover Account Type: Corporate Company Name: Account Number. Exp. Date: Address (Billing Address): FR St - I Sr .S ". City. State and Zip: NI tae GO yr:Iv:2K- NY /00 I Phone Number a ra - SD —01 reir Fax or Alternate Number I certify that all information is complete and accurate. I hereby authorize The Peninsula Spa, New York to collect payment for all charges as indicated on this form by processing a charge to the credit card listed above. I certify that I am the authorized signer of the credit card listed above. • e that we requir a handwritten signature in order to process this order. Cardholder Name (Pie• print): e7s.--6- Cardholder Signature: Date: pc_caS_ EFTA00314153