Adria Hotel Credit Card Authorisation Form
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1Adria Hotel Credit Card Authorisation Form
Dear Sir/Madam,
Please complete this 3rd party authorisation form and return to reservations@adria-hotel.co.uk 48 hours prior to the guests’ arrival. Full
information must be provided to ensure prompt processing of your application as well as a copy of the card holders identification and the
front side copy of the card to be charged We also ask that you to please make sure that the form is signed and dated prior to submission.
NB: All Credit card transactions are subject to an additional 3% processing fee. There is no processing fee for Debit card payments.
Booking Information
Number of Guests
Guest Name:
Booking Reference Number:
Total accommodation cost (£ GBP)
Date of Arrival:
Date of Departure
Please indicate whether you would like to add any of the following extras to your total. Alternatively please select ' No Extras' to
exclude this from your bill. All extras are priced per person per night.
Extras Continental Breakfast £
.00
No Extras
Full English Breakfast £
.00
5
8
Cardholder Information
Business
Account type:
Personal
Company Name
MasterDebit
Maestro
Card Type Visa
Visa Debit
Mastercard
Card Number
Name as shown on the credit/debit card:
Expiry Date
Cvv Number: (Not required if already provided)
Address
City, State
Zip / Postal Code Email
Phone Number
I understand that I am subject to the terms and conditions displayed in my booking confirmation and that a new form will have to be
completed if the guest wishes to extend his or her stay.
I certify that all information is complete and accurate. I hereby authorise Adria Hotel to collect payment for all charges as indicated in the
Booking Information section of this form by processing a charge to the credit/debit card listed above.
Cardholder name
(Printed)
Signature
Date
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Parent category: Business