POUR SEASONS

POUR SEASONS HOTEL vasty& ppzsrt‘e Q00 M THIRD PARTY AUTHORIZATION FORM FOR PAYMENT BY CREDIT CARD I - 3 -QFPP•G 4 a. POre-Iti authorize The Four Swans Hotel to charge my card foe the teservatuni nt , KARMA S3/44 w. RV, staying with us from Pee 14 to ljeC- 19 confirmation number is n case of wanton — I wish to take in chit. NO. if YES until what date 'bee-, gni+ lease encircle ckarly below which charges you wish to cover. Room: YES or NO Transfers YES or NO City Tax (2-S0C per adult per night) YES or NO Mini-bar & Telephone: YES or NO Breakfast: YES or NO Miscellaneous: YES or NO Full Expenses: () r NO Other expenses (please specify which): G-Ve--421 -.14 I 4 CI I. Card Holders Name: G. P are I j Card Molders Signature: Type of Credit Can!: Credit Card Number (last 4 digits only): ife c A - c- Y. C2 SS Expiry Date: 'Telephone Number. Facsimile Number: Bitting Address: (i7 la I 9 EAST -4 ( 37 Sr N\I1 1\i‘i /opal ftwas an a traartgaity.prataVill-m ihtk/Awiftg Ate you taking in charge the above? Travel Agency name: YES or NO Your IATA Number. PLEASE FORWARD A CLEAR COPY OF THE FRONT OF YOUR CREDIT CARD and of THE IDENTITY CARD OR PASSPORT of the credit end HOLDER FAILURE TO PROVIDE TIM ABOVE. INFORMATION PRIOR TO GUESTS ARRIVAL. Will. FORFErr THE USE OF 'MIRO PARTY PAYMENT AND GUESTS WILL SR AWED FOR AN ALTERNATIVE METHOD OF PAYMENT ON ARRIVAL. EFTA00313955