CREDIT CARD AUTHORIZATION FORM

CREDIT CARD AUTHORIZATION FORM Hotel- alHyatt Regency- Individual/Business/Group or Event Nam*: Reservation Confirmation Number: MI Arrival or Event (Weis): Credit Card Billing Address: 9 East 71st Street City / Stater Zip 1Countryi Region: Contact Phone Number: New Yorke NY 10021, USA Contact Email Address: • A valid telephone number and email are required as we will need to contact you to confum receipt. If we ore unable to do so, your reservation will be subject to cancellation. I hereby authorize the following charges to be applied to the following credit card. Check all that apply: j Room & All Applicable Taxes K Food & Beverage C All Incidentals CI Only SpectfK Incidentals D Resort Services Fee C GIh Certificate K All Banquet Charges C Parking hereby authorize the following amount be applied to the credit card (applicable sales tax and service charges may apply): El All Stay Charges K Guest Amenity r: Other see comments sac •In Australia: An additional service fee will apply to the total stay account when paying by AMEX, Diners and oil other credit cords upon departure (excluding Park Hyatt Sydney). Refer to the hoters webute for more details. Comments: • The credit card listed below may be billed for the estimated charges Ten (701 days prior to iwenterservetiondate. • Room and tax on individual bookings will be charged 72 hours in advance. Credit Card Number. Expiration Date: Name on Card: Jeffrey Epstein Cardholder Phone Is: I Signature of Card Holder kc anutagemgc/____ • Hotel reserves the right to refuse a credit card od payment for same day bookings or authorization received on day of arrival. 5/18(19 11 Current Date: SySubmitting this form and any supposing. . rs I tonfnm that. Nye read and agreed to rne v>e d the personal Information I am geeing you In atccedance with row GSOtwl Pr 'icy for Gaut whichisavailablea prnaKyhyatt corn Please fax this completed form to: Hotel Fax e: L For a Nit of all hotels and thrir contact infra motion. ;weave visit hrosilweise nyall.COrnihyatt1SitemaP ISO All information Is kept confidential end used only for the purposes as noted above o Pas ut411 acfleVal. lie a ire ate WYATT 14 /4 HYATT ANda criac ) EFTA00314042