DAYS INN HIGH PRAIRIE CREDIT CARD USE AUTHORIZATION FORM I hereby authorize DAYS INN HIGH PRAIRIE to have the following charges to my credit card. o Room, Tax & Sustainability Levy YES © Telephone NO o Laundry NO o Meal YES o Damage Deposit NO Guest Name:_Carmacks Enterprises Date/s of Stay: August 22, 2021 — August 28, 2021 Card Type:_MASTER CARD Card Number:_5193 9100 0048 7773 Expiry Date:_12/24 Please include your mailing address. This address must correspond fo your eredit card billing address. Name:_ ALLEN PILLOTT CARMACKS ENTERPRISES LTD. Address: __701— 25 AVENUE City:_NISKU Province:_ALBERTA Postal Code:T9E 0C1_ Phone number:_(780)955-5545 Fax number: Please sign below Must be Signaturg of Card Holder ONLY. Signature (eee Date:_JULY 13, 2021 Please provide photocopy of back and front of eredit card and copy of ID on an attached sheet. Days Inn High Prairie 4125 52" Ave., High Prairie Alberta* TOG 1E0 (780) 523-3050 Email: linda.maure@daysinnhp.ca Each DAYS INN is an independently own and operated franchise.