HOTEL CREDIT CARD AUTHORIZATION FORM
Individual/Business/Group or Event Name:
___________________________________
Reservation Confirmation Number:
___________________________________
Arrival or Event Date(s):
___________________________________
Credit Card Billing Address:
___________________________________
City / State / Zip / Country:
___________________________________
Contact Name and Phone Number:
___________________________________
Contact Email Address:
___________________________________
I hereby authorize the following charges to be applied to the following credit card. Check all that apply:
Room & Tax
_____
All Banquet Charges
_____
Only Specific Incidentals
_____
Guest Amenity
_____
Gift Certificate
_____
All Incidentals
_____
Food & Beverage
_____
All Stay Charges
_____
Parking
_____
Resort Services Fee
_____
Other
_____
Sales Tax Status
Taxable _____
Tax Exempt _____ Tax Identification # _____
I hereby authorize the following amount be applied to the credit card: USD $ __________________________.
I certify that I am the authorized holder and signer of the credit card referenced above.
I certify that all information above is complete and accurate.
I hereby authorize collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the
“AUTHORIZED AMOUNT” field. I understand this is only for up to this amount during the time period of
“_______________________” referenced above. If additional charges are going to be authorized, a new form will have to be
completed.
Credit Card Number:
___________________________________
Name on Card:
___________________________________
Expiration Date:
___________________________________
Cardholder Phone #:
___________________________________
Signature of Card Holder:
___________________________________
Please fax this completed form to Hotel Fax #:
_______________________
Very Important: Please read Page 2.
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