Third Party Credit Card Authorisation Form

Date: 3rd Party Credit Card Authorisation

Guest Name: Confirmation Number:

Arrival Date: Daily Date:

Departure Date: Type of Accommodation:

Specify Billing Instructions:

I, hereby authorize to use my

credit card for payment of
As specified below: (Pleases check one of the following)

( ) I will be responsible to pay all guests’ charges. (Room, tax, incidentals)

( ) I will be responsible to pay for guests’ room and tax charges only.
( ) I will be responsible to pay incidentals/extras only.

Print Clearly the Following information:

Credit Card Name:

Credit Number Expiration Date:

Name of Cardholder:

Address of Cardholder:

Telephones Number of Cardholder: Work Phone:

Signature of Cardholder: Date: