PI11. 11I li 11 Htl I. k

PI11. 11I li 11 Htl I. k 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 Departmen I, Jeffrey Epstein (print your name) authorize Rixos Hotel Premium Belek to ply the charge's of (print guest name) to my credit card. Arrival Date : St( tJe ail a0 Departure Date : t) (AL.`, it 4014 Approved Charles : Please initial the charges you wish to apply to your credit card. Charges K Room it Tax 0 Extra Expenses 0 Other Cardholder Information : Name as it appears on the credit card : Jeffrey Epstein and Card Type : OVIsa 0 Master Card Credit Card Number Exp. Date : 06/2018 .987 Address : where Amman n mailed) Total: 5.a3oo(O Phone number 4548 Fax number E-mail I certify that all inf rma ion is compete an 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 EFTA00313739