MANDARIN ORIENTAL NEW YORK ou 3'¢ PARTY CREDIT CARD AUTHORIZATION GUEST NAME: DATE OF TREATMENT:____ TIME OF TREATMENT: IT hereby authorize Mandarin Oriental, New York to charge my credit card for the charges indicated below for the above guest: Cardholder Last Name Credit Card # Exp. Date CJ Amex O Visa C) MasterCard C1 Diners | Oics (J Discover Billing Address City State Zip Country Telephone Fax Email Amount $ Approval Code: Item purchased [also, state quantity]: lassume responsibility for the above charges. Kindly fax mii to the attention of Mandarin Oriental, New York Spa Please check off the following: For Office Use only: ao Copy for Guest Processed by: Date: Copy for Spa Copy for Finance (IW) EFTA00286342