Tla RfrZCARD-Cr4.

Tla RfrZCARD-Cr4. St. Mkt Dear Sir/Madam, Credit Card Authorization Form This form has been created in order to allow you to have third party expenses charged to your credit card. Please provide all the information requested below to ensure prompt processing of your application. We ask you to please sign and date the form before submission. Please fax the completed form to 310493-3839. Cardholder Information Name as it appears on the credit =4: Card type: Account type: Account number: Address: NI.rertrwrini•arsre City. State and Zip: Phone number Guest Information Guest name: Comps Phone number: Confirmation number: Arrival date: Relation to cardholder. -Te-CC,ce C. Eps4en Visa D MC ZI Amex C I DinersiCB CI Discover LI CB ZI Individual (personal credit card) K Corporate I Company Nam= (.0) NCO 129. \ Exp. chte: s;\ q CI crA Ths1 sme-t- NleW \\C.Kt, t\\rk).) \Of k (Dog k a•-)- -1s)O-cA%cif3 Fax or alternate number Leske\A G,(occ Fax or alternate number Departure date: sec\ . ;)?,(D , 3015 K Relative Q Friend V Business Associate CI Other Rate Information and Approved Choral Room rate:* Taxca:• row daily rate:* Number of nights: '(Rate and tax amount must be provided by a howl representative in order to complete this form) V All Charges D Room & Tax D Tcicphone(LD) Q Telephone (Local) CI Restaurant CI Room Service El Valet (Laundry) D Parking Q HS Internet Access CI Movies LI Other: I certify that all information is complete and accurate. I hereby authorize THE RITZ-CARLTON CLUB to collect payment for all charges as indicated in the Rate Information and Approved Charges section of this form by processing a charge to the credit card listed above. Charges must not exceed - for the entire stay/event. I understand that a new form will have to be completed if guest wisherfo-ectend hisrber stay. I certify that I am the authorized signer of the ed above. Cardhoder name: orwwe Cardholder signatac: tags IL L *WPM MD ek4re-i,p k I Date: - ate — EFTA00310257