Akarnott.

Akarnott. HOTELS & RESORTS Credit Card Authorization Form Dear Sir/ Madsen, This form has been cicala in order to allow you to have thinl party expenses charged 41 your creditklebit card. Please preside all the infommtion requested below to ensure prompt processing of your application. We ask you to please sign and date the form he hire submission. Please fax the completed form to 340at 7156193 Cardholder Information - Remitted Name as it appears on , the crtdil'debit card: Jett- Card type: Account type: K vim O MC ['Amex O DinerviCB a -Personal O Corporate I Company Name: K DiSCover K KB Issuing Bank: Aifs1VACAta G Y.7 Ft c 3 S Phone a: Account number: Exp. Date: L, Address: inc. gambol is emr City. State and /in: Net.A.N NN ICOa1 Phone number: Fax or alternate number Guest deformation - Reams Cum name. Ice/it nfA1nte Address. City, State and Zip: Company: Phone number: Confirmation number: Arrival date: PAeCH a D Departure date: it-oech Relation to cardholder: O Relative O Friend ariusiness Associate O Other s I understand that dintid there be any issues with the credittabit cad being used to settle my charges. I sill be tespensibk for all en:exists incurred during my stay. Depurate dare cannot be extended unless a new authorization form is completed. Guest name innao Guest signature. [km Rate Information and Approved Chiral" - Rcouired Room tate:0*, 4, --k--) .1,4al daily rate:* Number of nights: •( Rate and tax amount must he provided by a hotel representative In order to complete this form) ILYA II Charges O Room & Tax El Telephone (1..D) O Telephone (Local) O Restaurant O Room Service O Valet Laundry) O Parking K liS Internet Access O Movies O Other 1 certify that all information is oirinpIctc and accurate I hereby authorize Frenchman's Reef & Morning Star Marriott Bach Resort to corm payment for charges as uidicaed in the Rate Intl:nation d Approved Charges sectional this form by processing a charge to the irciblidebit card listed above. Charges must not exceed .0 f..) . D zI for the emcee ayes ent I understand that a new form will have to be completed if guest wishes to 0.4:IXI hisTher tay lardy that 1 an the auttrunced signer of the crethmletnt card listed above , Cardholder name. rosin Cardholder signalize. ?altar 3- EFTA00313713