Credit Card Authorization Form - Crowne Plaza Hotel/holiday Inn Express


Credit Card Authorization Form
I hear by authorize the Crowne Plaza Hotel/ Holiday Inn Express,
Springfield, IL, to charge my: ______________________________
(Type of credit card, i.e.: Visa, Mastercard, Discover etc.)
Account Number (if applicable):_____________________________
Expiration Date:_________________________________________
Print Name as it appears on front of credit card:
Authorized Signature:_____________________________________
Group Name: Township Officials of Illinois_ Date of Arrival:_______
Sales Manager: Judi Elliott___________________________________
Credit Card to be charged for:
____ Food and Beverage & Meeting Room Rental
____ Overnight Accommodations (Room & Tax)
____ Overnight Accommodations (Room, Tax & Incidentals)
____ Other (Please Describe)
Your final estimated payment is due 5 business days prior to the function/arrival date and
will be charged to the credit card on file. If a balance is remaining after the event; the
credit card on file will be charged for the remaining balance.
Fax completed form to Darlene Sidwell, 217-585-1373.


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