Credit Card Authorization

Date:
To: The Tokyo Station Hotel
1-9-1 Marunouchi Chiyoda-ku, Tokyo100-0005, Japan
Tel: +81-3-5220-1112/Fax: +81-3-5220-0512
E-mail: info@tokyostationhotel.jp

I
charge for the amount of
Mr/s.

, hereby authorized The Tokyo Station Hotel to

JPY, (or below billing instruction) against
.

Billing Instruction *Please tick the boxes indicating what can be charged your credit card.
All Bills

Room Charge only

Breakfast Dinner Internet Telephone Car Hire Laundry Business Centre

Early check-in charge Late check-out charge Others (

Credit Card Type

Credit Card Number
Card Holder Name
Expiry Date
I agree that in the case of a no show, cancellation or amendment, charges will be made at
discretion of the establishment to my card.
I understand that this is indisputable charge and I have executed this undertaking with absolute
finality and good faith.

Signature:

This form is to be filled in and signed by the credit card holder ONLY. A clear copy of both sides
of the Credit Card with the card holders signature and should be sent along with this form.