11-04-12

Bethany Grayczyk
457 South Fargo St
Oregon Oh

Oregon OH 43616
United States

[Date

Room No.

Arrival

11-02-12

Group Code

CST

Departure

11-04-12

Company

Soccer

Conf. No.

62050553

Membership No.

Rate Code

invoice No.

Page No.

Description

I 'Charges I

11-02-12 *Accommodation
11-02-12

513

Folio No.

A/R Number

1 of 1

Credits

109.00

State Tax

7.90

11-02-12 Occupancy Tax

5.56

11-03-12 *Accommodation

109.00

11-03-12 State Tax

7.90

11-03-12 Occupancy Tax

5.56

11-03-12 MasterCard

244.92

Total
Balance

244.92
0.00

Guest Signature: ' @'@

I have received the goods and / or services/irfhmount shown heron. I agrtat my,[Ja for .thoill is not waived and agree to be held
personally liable in the event that the indic&ted"person, company, or associate fails to pffor anprt or the full amount of these charges. If
a credit card charge, I further agree to perform the obligations set forth in the cardholder's agreement with the issuer.

Holday Inn Express & Suites Columbus, OH

8670 Orion Place

Columbus, OH 43240
Telephone: (614) 781-6100 Fax: (614) 781-0700
Independently Owned by Badrivishal, LLC and operated by Alliance Hospitality, Inc.

244.92