Days Inn High Prairie

Box 820 4125-52 Avenue

High Prairie, Alberta, T0G1E0
Phone: (780) 523-3050
Fax: (780) 523-3181
reservations@daysinnhp.ca

Credit Card Authorization Form

I hereby authorize Days Inn High Prairie to charges to be applied to the following credit card.

ON GOING ____________ yes

ONE TIME ONLY ____________

4536010017195904 (cvc 285)

VISA # __________________________________________ 11 22
EXP __________/___________

M/C # __________________________________________ EXP __________/___________

AMEX # _________________________________________ EXP __________/___________

Please check off all that apply.

Room, Tax & Incidentals___________ Laundry Services___________

Alcohol ___________ Charge Meals___________

Maxime Carriere (Done Rite Fire Protection Inc)

Name of Card Holder : ______________________________________________________

Signature of Card Holder :____________________________________________________

Please Photocopy front and back of credit card along with 2 pieces of photo ID and fax or
email to number/email provided.

Charles Bazerd, Revink Salih

Guest Name(s): ________________________________________________

Done Rite Fire Protection Inc

Company Name: ________________________________________________

Jannuary 25 2021
Date of Arrival: ________________________ Jannuary 29 2021
Date of Departure: _________________________

max.carriere@doneritefireprotection.com
At check out fax or email mail receipt to: __________________________Or give receipt to guest.

Please fax or email to the Days Inn High Prairie prior to guest arrival.