9740 Commerce Center Ct, Fort Myers FL 33908
Credit Card Authorization
Joseph Zimmer
In Lieu of my credit card imprint I, ______________________________________, hereby authorize
AD1 Hotels Fort Myers, Candlewood Suites Fort Myers Sanibel Gateway to charge my credit card
in the moment that the Fax Authorization is received.
4270880093620904
_________________________ 01/27
- _______ Elite pool construction llc
_______________________
(Credit Card Number) (Exp. Date) (Company Name)
Francisco Lopez
_______________________________ _____________________________
(Guest Name) (Confirmation Number)
03/12/2023
_______________________________ 03/13/2023
_____________________________
(Arriving Date) (Departure Date)
Circle One of the following:
A) Room & Tax Only***requires Credit card from guest at check in for incidentals
B) Room, Tax and Incidental Charges (restaurant charges, damages, etc)
Circle One of the following:
Will the guest(s) have a valid credit card in their name available for incidentals at check-in?
YES or NO ***If NO the hotel requires a valid Credit card from guest for incidentals***
I authorize guest to extend reservation past departure date noted above YES or NO
My billing address is: __________________________________________________________________
611 NW 20th st (Street Address)
Cape Coral Fl 33993
2392661275
_____________________________________________________Phone :(_____)_________________.
(City, State, Zip Code)
By signing below, I acknowledge charges describe herein,
_________________________________________ 03/12/2023
Date:_______________
(Signature of Cardholder )
*****Please provide a clear photocopy of the Credit Card (Front and Back) and the cardholder’s
driver’s license with this form. This Form must be receive at least 24 hours prior to arrival. *****
****Please fax this form back to (239) 432-1735 or email it to print@ftmyerscandlewood.com****