Credit Card Authorization Form For Use With Truman State University'S P-Card Program - Holiday Inn Express Hotel & Suites

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Holiday Inn
EXPRESS
2702 SOUTH BUSINESS HWY. 63 · KIRKSVILLE MO 63501 · PH (660) 627-1100 FX (660) 627-5876
HOTEL & SUITES
CREDIT CARD AUTHORIZATION FORM
for use with
Truman State University’s P-Card Program
I, ____________________________________, hereby give the Holiday Inn Express Hotel &
Suites Kirksville MO authorization to charge my Truman P-Card for the charges incurred by the
following guest(s):
Guest Name: _____________________________ Confirmation #:_______________________
Arrival Date: _________________________ Departure Date:___________________________
The charges that will be covered by the card include:
Room and Lodging Tax ONLY
Room, Lodging Tax and Incidentals (including phone, fax and photocopy charges)
*Cardholder will be responsible for stating the business purpose of incidental expenses on the hotel folio.
Truman State University is exempt from Sales Tax, MO Tax ID No. 10001824
Credit Card Information:
___ American Express
Card Number
_ _ _ _ – _ _ _ _ – _ _ _ _– _ _ _ _
:
X Visa (TRUMAN P-CARD)
Expiration Date: ________________________________
___ Master Card
Name of Cardholder: ____________________________
___ Discover
Telephone Number: _____________________________
___ Diners Club
Fax Number: __________________________________
Cardholder Signature: _______________________________
Date: ____________________
Printed Name: _____________________________________
NOTE: The hotel must receive a photocopy of the front and back of the credit card along with a copy of the
cardholder’s TRUMAN PHOTO ID. Charges will be issued without proper cancellation.

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