EFTA00317375.pdf

THE MARK CREDIT CARD BILLING AUTHORIZATION FORM GROUP GUEST INFORMATION COMPANVGROUP NAME CONTACT NAME INDIVIDUAL GUEST INFORMATION GUEST NAMES ARRIVAL DATES DEPARTURE DATES on-r. iti-, zo Lc- tcras CHARGES TO BE BILLED (please indicate by marking an X in the appropriate boxes below) ArS =AR= (3 CATERING AND MEETING CHARGES (1 GUEST ROOMS &TAXES (1 GRP ROOM DEPOSITS: AMOUNTS (1 GUEST INCIDENTALS (3 CATERING DEPOSITS: AMOUNT S (1 OTHER (Description): PLEASE NOTE THAT UPON RECEIPT OP TFIIS FORM THE CREDIT CARD WILLIE CHARGED FOR THE PM AMOUNT OP ROOM AND TAX. El YOU OPT TO COVER ALL CHARGES, ME INCIDENTAL CHARGES WILL BE SETTLED UPON CHECKOUT OP THE GUEST. CARD HOLDER INFO CARD NUMBER: EXPIRATION DATE NAME ASR' APPEARS ON CARD: . re PrierOsN) CARD BILLING ADDRESS: q AS-r CITY: STATE AND ZIP CODE: N 1 I 0 0 ') TELEPHONE -4L IIMMEMIF PAX: EMAIL: [ 1 AMERICAN EXPRESS [3 VISA ( 1 MASTER CARD (1 DINERS CLUB DISCOVER (1 JCB I HEREBY AUTHORIZE THE MARE HOTEL TO USE THE CREDIT CARD INFORMATION PROVIDED ON THIS FORM EITHER AS PAYMENT FOR THE CHARGES DESCRIBED ABOVE. I AM AWARE SUPPORTING DOCUMENTATION WILL ACCOMPANY AU. CHARGES. BY SIGNING BELOW I AGREE TO PAY MY CIU3DIT CARD CHARGESAGREED TO ABOVE IN ACCORDANCE WITH MY CARDHOLDER AMBIENT. CARD HOLDER'S SIGNA DATE SIGNED: OLT, • PLEASE ATTACH:1) A LEG OTO • Ft OF PROOF OF IDENTIFICATION 2) FRONT AND BACK O CREDIT CARD YOU WISH TO CHARGE 25 East n th S• New Yor NY to USA Tel Toll free reservations: 0 EFTA00317375