GRAND PALACE HOTEL | @ RIGA - LATVIA Pils street 12 + a + LV 1050 + Latvia www.grandpalaceriga.com CREDIT CARD AUTHORISATION FORM Reservation for: Reservation from: Reservation until: Reservation Nr. I authorize “Hotel Grand Palace” Ltd, (Pils street 12, Riga, Latvia, VAT reg. nr. LV40003378078) to charge the amount of EUR from the below mentioned credit card for all requested services.* Type of Credit Card: Credit Card Number: Cryptogram number (CVC): Expiry date: Holder’s Name: *Request cannot be processed without a legible front and back side copy of the credit card. Holder’s signature: Date: Company stamp: (if applicable) kd Est r928 THE LEADING HOTELS OF THE WORLD® EFTA00301019