Guest Credit Card/debit Card Payment Form - 2017 printable pdf download

Guest Credit Card/debit Card Payment Form - 2017

Guest Credit Card/Debit Card

Payment Form - 2017

*Forms MUST be returned to the Hilton Credit department 2 weeks/14 days prior to

arrival for processing as forms will not be accepted without meeting this criteria *

This Credit card form will not be accepted on date of arrival for guest(s) payments

*Your card will be charged immediately ** Forms are processed Monday - Friday only*

**This form cannot be hand carried in, it must be received per the instructions above prior to arrival**

Guests Name:

Confirmation Number:

Date(s) of Arrival

I authorize the following charges, marked below, to be billed to my credit card.

ALL CHARGES Incurred during the above guest(s) stay

Room & Tax Only

Restaurant/Room Service ChargesSelf Parking

Valet Parking

Self Parking

PROVIDE THE CREDIT CARD NUMBERBELOW

Forms must be returned to the Hilton Credit department by FAX at 210.222.0235

Or via Email at

Your credit card will be charged immediately for the items indicated above

Please note- A debit card authorization will remove funds from your account immediately

It may take up to (14) business days to release holds on debit accounts

No shows or Late Cancels will not be refunded by the Hotel **Forms are processed Monday - Friday only**

I hereby authorize the Hilton Palacio del Rio to charge for all items indicated above to my credit card per my

contractual agreement:**All below fields are required as this form cannot be processed without this information **

Credit Card Number:

Exp Date:

/ CVC#

Name on Card (please print):

Card Holder

Billing Address:

City:

State:

Zip Code

Authorized Signature:

Date:

Phone Number

Email:

H I L T O N P A L A C I O D E L R I O

200 S. Alamo | San Antonio | Texas 78205

T: + 1 (210) 224 3314 F: +1 (210) 222 0235

Guest Credit Card/debit Card Payment Form - 2017