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Holiday Inn South Bells Road


4303 Commerce Road, Richmond, VA 23234
Phone: (804) 592-2900
Fax: (804) 525-7271

Credit Card Authorization Form

Today’s Date: _________________

Company Name: ________________________________________

Date of Event: _____________________

Charges Authorized to Bill to the Credit Card:

Meeting/Catering Charges _____

Audio Visual Charges _____

Sleeping Room & Tax _____

Incidental Room Charges:


Phone _____
Restaurant Meals _____
Parking _____
Dry Cleaning _____
All _____
Other ___________________________________

Type of Credit Card: ___________________________________

Credit Card Number: ___________________________________

Expiration Date: ___________________________________

Name on Card: ___________________________________

Authorization Signature: ___________________________________


Please include a copy of the front and back of the credit card
as well as the card holders identification card

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