Credit Card Authorization Form

This form has been created in order to allow you to have third party expenses charged to your credit card. Please provide all the information
requested below to ensure prompt processing of your application. We ask you to please sign and date the form prior to submission. Please fax the
completed form to the front desk at 803-407-6366. Along with this form we will need a copy of the front and back of the credit card and a copy of
photo identification with a signature matching the name on the card.

Cardholder Information

Name as it appears on the credit card: Rita R Novotny

Card Type: Visa Master Card American Express Diner’s Club/CB Discover

Account Type: Individual (Personal Credit Card)

Corporate – If corporate, Enter Company Name: Triship Partners

Credit Card Number: 5348 6900 0365 0791 Expiration Date: 09/24

Billing Address: PO Box 82803

City, State, and Zip Code: Atlanta, GA 30354

Phone Number: (678) 409-0965 Fax or Alternate Number:

Guest Information

Guest Name: Hannah Payne

Company: Triship Partners

Phone Number: (470) 526-8053 Fax or Alternate Number:

Confirmation Number: 97784469 Email: hannah@trishippartners.com

Arrival Date: Monday June 19, 2023 Departure Date: Wednesday June 21, 2023

Relation to Cardholder: Relative Friend Business Associate Other:

Approved Charges

All Charges Room & Tax Only Meeting Space Only Long Distance Phone

Bar Restaurant Market/Grocery Laundry/Dry Cleaning

Other:

I certify that all information is complete and accurate. I hereby authorize (insert your hotel name and location here) to collect payment
for all charges as indicated in the Rate Information and Approved Charges section of this form by processing a charge to the credit
card listed above. Charges must not exceed $500.00 for the entire stay/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 the authorized signer of the credit card listed above.

Cardholder Name: (Printed) Rita Reana Novotny

Cardholder Signature: Date: 06/19/2023