Hotel Credit Card Authorization Form

Hotel Information

Name of Hotel

Mailing Address

Hotel's Mailing Address

Street Address

Address Line 2

City

State

ZIP Code

Guest(s) Name(s)

Do you know the Name(s) of the Guest(s) staying at the Hotel?

Do you know the Name(s) of the Guest(s) staying at the Hotel? YesNot right now

Name(s) of the Guest(s)

Name(s) of the individual(s) staying at the Hotel

Items Being Charged

What is going to be charged to the Cardholder?

What is going to be charged to the Cardholder? Hotel Room, Taxes, and FeesMini-Bar Snacks and BeveragesRoom ServiceRecreation / Resort FeeOther

Dates

Do you know the Check-in and Check-Out Dates?

Do you know the Check-in and Check-Out Dates? YesNot right now

Check-In Date

Check-Out Date

Hotel Room

Do you know the Amount of the Hotel Room (including fees and taxes)?

Do you know the Amount of the Hotel Room (including fees and taxes)? YesNot right now

Amount of Hotel Room plus Taxes and Fees

Mini-Bar Snacks and Beverages

Do you know the price of the Mini-Bar, Snacks, and Beverages?

Do you know the price of the Mini-Bar, Snacks, and Beverages? YesNot right now

Amount of Mini-Bar Snacks and Beverages

Room Service

Do you know the Amount for the Room Service?

Do you know the Amount for the Room Service? YesNot right now

Amount of Room Service

Recreation / Resort Fee

Do you know the Amount for the Recreation / Resort Fee?

Do you know the Amount for the Recreation / Resort Fee? YesNot right now

Amount of Recreation / Resort Fee

Other

Do you know the Amount of the "Other" Charges?

Do you know the Amount of the "Other" Charges? YesNot right now

Amount of "Other" Charges

Can you Describe the "Other" Charges?

Can you Describe the "Other" Charges? YesNot right now

Describe

Total Amount

Do you know the Total Amount that is to be charged?

Do you know the Total Amount that is to be charged? YesNot right now

Total Amount to be Charged

Cardholder Information

Do you know the Name of the Individual or Organization being charged?

Do you know the Name of the Individual or Organization being charged? YesNo

Individual / Organization Name

Do you know the Cardholder's Credit Card Information?

Do you know the Cardholder's Credit Card Information? YesNot right now

Type of Card

Type of Card AMEXDiscoverMasterCardVisa

Cardholder's Name

16 Digit Credit Card Number

Expiration Date

Security Code

Usually the 3 Digits on the back of the card

Billing Address

Street Address

Address Line 2

City

State

ZIP Code

Cardholder's Signature

Is the Cardholder available to electronically sign now?

Is the Cardholder available to electronically sign now? YesNo

Cardholder's Signature

Clear

Please draw your signature.

By signing this form, you give the Hotel permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

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