EFTA00316215.pdf

CREDIT CARD AUTHORIZATION I hereby authorise The Four Seasons Hotel Firenze — CU.GI.MI. S.p.A. to charge my credit card below CREDIT CARD TYPE: American Express Visa Mastercard Diners Club JCB CREDIT CARD NUMBER: 3767 644 yoo /Soo/ exp: i/4 6- CREDIT CARD HOLDER: ths-Fc-4-ey epsrEin/ Print name Signature Specific types of charges which my credit card can be used am (please circle) drECCHARG4) . ROOM & TAX FOOD & BEVERAGE BANQUET OTHER CHARGES (please specify): Guest Name : Xilt/ 2-YAnt- S it-c< e14- ,/< Arrival Date : Departure Date If your credit card has a currency different from euro and supported for Dynamic Currency Conversion, you can choose to pay in USD. The Currency amount on your card transaction receipt will be the amount that you will be charged to your card issuer. The Exchange rate to calculate the transaction Currency amount will be determined on the day that the order is processed. Currency Conversion for this transaction is performed by Global Blue (www.global-blue.com).The reference rate for currency conversion is based on the Global Blue Reference rate. Mark up on the reference rate: 3% Please confirm if you wish the charge in your currency yes 0 no 0 WHERE TO SEND THE COPIES OF THE BILLS: Jeff : 12-63 eps Name / Company: 9 ectrir S X-r Address: City & Postcode: Afew Vail/C AIL/ coo -2- ( I Phone Number o2/ 02 - 7-ro — 9 e ***FOR YOUR SAFETY WE WOULD LIKE TO REQUIRE A LEGIBLE PHOTOCOPY OF THE FRONT AND BACK OF THE CREDIT CARD TOGETHER WITH A GOVERNMENT ISSUED PHOTO ID IS MANDATORY TO AUTHORISE APPROVAL *•* FOR YOUR SAFETY PLEASE BE SO KIND AS TO CANCEL THE CVV CODE FROM THE COPY "•* BORGO PINTI, 99, 50121 FIRENZE, ITALY TEL: +39 055 2626250 FAX: +39 055 2626504 EMAIL: EFTA00316215