FAIRFIELD INN & SUITES ATLANTA CUMMING/JOHNS CREEK

Credit Card Authorization Form

Name on the Card:

Type of Card: Visa MC AmEx Discover

Account Number

Expiration Date

Security Code

Billing Address

City, State, Zip

Phone Number

Guest(s) Name(s)

Date(s) of Stay

Authorized Charges: Room & Tax ONLY

(Select One) All Charges
Group Block or Reservation Hold ONLY

By signing this form, you authorize Fairfield Inn & Suites Atlanta Cumming/Johns Creek
to charge or use your card for the type of charges or uses selected above.

Signed: Date:

PLEASE INCLUDE A PHOTOCOPITED IMAGE OF THE FRONT AND BACK OF THE AUTHORIZED CREDIT CARD
AND THE AUTHORIZOR’S IDENTIFICATION.