CREDIT CARD AUTHORIZATION FORM Hotel: Individual/Business/Group or Event Name: Reservation Confirmation Number. 'EV H `I OCIA55-4.8',5-1 (se Arrival or Event Date(s): re 6. - j D Credit Card Billing Address: I I 4ST • QQ al City I State! Zip i Country Reg on: Contact Phone Number: Contact Email Address: • A valid telephone number and email are required os we will need to contact you to onfirm receipt. If we are unable to do so, your reservation will be subject to cancellation. I hereby authorize the following charges to be applied to the following credit card. Check all that apply: Bloom & All Applicable Taxes K Glft Certificate eAll Stay Charges fiood & Beverage 7 Only Specific Incidentals D All Banquet Charges C Guest Amenity Incidentals 1Xnet.Oft Services Fee E Parking C Other - see comments I hereby authorize the following amount be applied to the credit card (applicable sales tax and service charges may apply): Comments: ifoct. no •In Australia: An additional service fee will apply to the total stay account when paying by AMEX Diners and all other credit cards upon departure. Refer to the hotel's website for more details. • The credit card listed below may be billed for the estimated charges Ten (10) days prior to event/reservation date. • Room and tax on individual bookings will be charged 7) hours in advance. Credit Card Number. Expiration Date: Name on Card: Cardholder Phone*: Te: F)-2 tr.N us-ro rl Signature of Card Holder: Current Date: I ret, 5, ably • Hotel reserves the right to refuse a credit card authorization a slid ethod of payment for same day bookings or authorization forms rec day of arrival. a /By stbmitting this form and any supporting dckuMPOIS. C em that / have read and agreed to the me a the personal Informationam giving you in accordance with your Global Privacy Pcky for Guests. veh kh is available at privacy.hyab.com Hotel Fax a: Please fax this completed form to: CIF- For a In of all h