I'tiF\I I 1 ‘I B F. I

I'tiF\I I 1 ‘I B F. I CREDIT CARD AUTHORIZATION FORM Dear Sir! Madam. 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 Rixos Hotel Premium Belek Reservation Department I, Jeffrey Epstein , (prutt your name) authorize Rixos Hotel Premium Belek to apply the charge's of (print guest name) to my credit card. Arrival Date : 51.41.16 alto° r-4- Departure Date : JIALN 14, at) I Dr Approved Charges : Please initial the charges you wish to apply to your credit card. Errill Charges K Room & Tax Extra Expenses K Other Cardholder Information : Name as it appears on the credit card letTrey Epstein Card Type : bursa O Master Card and Credit Card Number Exp. Date : 06/2018 r:987 Address : (where Internal! i, inaikd) Total: Phone number Fax number E-mail I certify that all inf is complete and accurate. I hereby authorize Rixos Hotel Premium Belek to collect payment for all charges as indicated in the Rate Information and Approved Charges section of this form by proccessing a charge to the credit card listed above. Charges must not exceed fort he entire any event. I understand that a new form will have to be completed if guest wishes to extend his/her stay. I certify that I am authorized signer of the credit card listed above. Cardholder name : Jeffrey Epstein EFTA00313730