EFTA00313714.pdf

)Xarruott. HOTELS & RESORTS Credit Card Authorization Form Dear Sir/Madam, This form has been credted 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 - Rectuireg Name as it appears on the credit:debit card: Card type: S'isa 0 MC Er/unex 0 Diners/CB Discover 0 JCR ❑ Account type: Er Personal 0 Corporate I Company Name: Ratting Bank: Account number: Exp. Date: Address: 101.00 Cak00.04 a Ma 004 q PAss—r 3 tsar Si— City. %lair and Zip: Nr--;44.1 NI') 'CADA Phone number: Fax or alternate number. Guest Information - Reaulred Guest name: Address: City. State and Zip: Company: Phone number: rax or alternate number. Confirmation number: OrRO1 Arrival date: JaAee r a()I1- Departure date: ILI A RC,-4 ,-QZ o1C Relation to cardholder: 0 Relative 0 Friend allusiness Associate 0 Other under and that should there he an) miles with the credit,debit card being used to settle my charges I will be responsible fire all expenses incurred during my stay Departure dare cannot be extended unless 0 new authorization form is completed. Guest name :FT•4^1. Guest vignsure [Yaw Rate Information and Approved Charges - Required Room rate:* faxes:. vital daily rateI Number of nights: •(Rate and tax amount must be provided by a hotel representative in order to complete this form) ErAll Charges 0 Room & Tax Telephone (LD) 0 Telephone (Local) 0 Restaurant 0 Room Service 0 Valet (Laundry) 0 Parting 0 HS Internet Access 0 movies 0 Other: I stilly that all information 10 complete and accurate I hereby asithimis Frenchman's Reef & Morning Star Marriott Beach Resort to collect payment for all charges se unbelted in the kale Informatson and Approved Charges section of this form by proctistrig a dirge to the credit/debit card listed above. Charges mist not exceed V(--re CC) fix the enure stay/event Understand that a new form will have to be completed if guest wishes to extend hather stay. 1 certify that I am the authorised signer of the credit,'deba card lined above. Cardholder name. inssios Cadhohler signature. Date 3 I.±- Iteriees. -tifitt}ril EFTA00313714