Credit card debit authorization form

CREDIT CARD DEBIT AUTHORIZATION FORM

Thank you for filling this form and attach a copy of the credit card and ID card holder. We will not be able to charge the credit card if we do not receive all these documents. This file must be filled in and signed by the credit card owner.

I, Mister/ Madam ……………………………………….. authorizes The Grand Balcon Hotel to charge my credit card for the stay of:

Mr/Mrs……………………….…………from.........................to...................................

Credit card number:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiration date:

__ __ / __ __ __ __

Security code:

__ __ __ __

For the following benefits (please check your choice):

o Room

o Breakfast

o City tax (1.5€ per day and per person)

o Extra charge

For an amount of ………………..€

City: ………………………………….. The: ……………......

Credit card holder signature:

o I confirm I attached all the documents requested in the authorization form. I am aware without these documents the file is not valid.

Дата добавления: 2015-11-04