Your Hotel

Your Hotel Address

City, Province, Postal Code Web Address
Telephone: 000-000-0000 Fax: 000-000-0000 Toll Free: (000) 000-0000

Credit Card Authorization Form

Date

I, _____________________________________ hereby authorize the use of my credit card as the

method of payment to cover the following charges as stated below:

 Guest room and taxes only for each night. Individuals pay own incidentals

 All Charges including guest room, applicable taxes, meals, phone charges, and any other
incidental charges for each night

 All banquet room charges including food & beverage charges, where applicable, for each day

 Both banquet room charges, including food & beverage charges, where applicable, for each
day and guest room and applicable taxes only for each night. Individual pay own incidentals.

 Both banquet room charges, including food & beverage charges, where applicable, for each
day and all charges including guest room, applicable taxes, meals, phone charges, and any
other incidental charges for each night

 Other. Please advise.

For the reservations of Confirmation #

Arriving on Number of Nights

Type of Credit Card:  Visa  MasterCard  American Express

 Discover  JCB  Diners Club/Enroute

Type and Credit Card Number Expiry Date

Name of Cardholder E-mail Address

Cardholder Signature

www.hotelskonsultan.webs.com
Cardholder’s Business Phone Home Phone

Please Note: This Authorization Form is not valid without a photocopy of the front and back of
the credit card.

www.hotelskonsultan.webs.com