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    Inbound 402785649529909318

    Uploaded by

    Athena Barnett
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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Inbound 402785649529909318

    Uploaded by

    Athena Barnett
    246 views1 page
    Cc

    Original Title

    inbound402785649529909318

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Cc

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    246 views1 page

    Inbound 402785649529909318

    Uploaded by

    Athena Barnett
    Cc

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Credit Card Payment Authorization Form

    Do not send completed form by email.

    FAX COMPLETED FORM TO: ATTN:

    Date: 06/08/2024

    HOTEL USE ONLY:


    Guest / Group Name:
    Aaron Fulcher
    Check-In / Event Date:
    06/08/2024
    Name of Person/Group Making Reservation: REVIVAL CONSTRUCTION Phone: 5126080862
    Authorized Amount: 240.00 Approval Code: Date: 06/08/202

    CARDHOLDER - Please complete the following section and sign/date below.


    Cardholder Name as it Appears on Credit Card: JAN STEWART

    Cardholder Billing Address: 1101 1st Streetsuite#216CoronadStreetsuite#216


    City: CORONADO State: CALIFORNIA Zip: 92118
    Daytime /Business Telephone: Evening Telephone:
    Credit Card Number: 5289 4275 7609 5174 Expiration Date:
    Credit Card Type: (Check one) ☐ Visa ☐ MasterCard
    ☐ American Express ☐ Discover ☐ JCB ☐ Diners Club
    Credit Card Issuing Bank Name: _____________
    CAPITAL ONE NABank Security Number (from back of your credit card): _______________________
    591

    I agree to cover the following categories of charges: (Please check)


    ☐ All Charges ☐ Room & Tax ☐ Food & Beverage ☐ Retail ☐ Recreation

    I agree to cover the above categories of charges up to a Maximum Amount of $ ALL CHARGES

    Note: Charges for room and tax, group deposits or direct bill account payments will be charged to your credit card immediately. Any
    incidental charges circled above will be charged at the time of check-out.

    Amount to be immediately charged to credit card for room and taxes or deposit: $

    Final Balance Billed to Credit Card (hotel use only): $

    By signing below, you authorize the hotel to charge your credit card immediately for the amount indicated above up to the “Maximum Amount”
    indicated above. You further acknowledge that if “all charges” has been selected, then all guest/group related charges (less Deposit) will be
    charged to the above card number at the time of checkout or event conclusion.

    Cardholder Signature: Date: 06/08/2024

    Made Fillable by eForms

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