Telephone Order Authorization Request Form: Dubai Jumeirah

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Dubai Jumeirah

TELEPHONE ORDER AUTHORIZATION REQUEST FORM


Please complete the below form and fax it back to +971 (0)4 3182218:
I Mr./Mrs./Ms._____________________________________ Authorize: Hilton Dubai Jumeirah
to debit the sum of AED._______________ Amount in words________________________________
__________________________________________ For the stay of Mr./Mrs./Ms. ________________
________________________________________ From ________________ till ___________________
Charge Type:-

Room Only

Entire Account

Others ________________________

Merchant Number: 240108


My Card details are:
(Please tick the appropriate box)
American Express
Master card

Visa card

Diners

Name on Card: ____________________________________________


Card Number:_____________________________________________
Expiry Date: ____/________MM/YY
Bank Name & Country: _____________________________________
Billing Address (The address on which Credit Card bills are received):
____________________________________________________________________________
____________________________________________________________________________
Telephone number:_______________________ Fax number:_______________________
Guest signature:________________________________

For Hilton Dubai Jumeirah use only


Managers Name:____________________________

Signature:_____________________

For Credit Card Company use only


This transaction is:
Approved
Code:________________

www.hilton.com

Declined

Approval/Authorization

Hilton Dubai Jumeirah


P.O. Box 2431
Dubai, United Arab Emirates
Tel: +971 (04) 3182111 Fax: +971 (04) 3182218
Worldwide Reservations: 800 4243 or www.hilton.com

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