Tre Rrtz-Cariton® Credit Card Authorization Form St. Taos ee Dear Sir/Madam, This form has been created in order to allow you to have third party expenses charged to your credit card. Please provide all the information requested below to ensure prompt processing of your application, We ask you to please sign and date the form before submission. Please fax the completed form to 340-693-3839. Cardholder Information : Name as it appears on the credit card: JELLR\ t - E iD aie WwW) _ Card type: OQ viss (] Mc QQ amex () DinersicB () Discover (J) JCB Account type: WY Individual (personal credit card) CJ Corporate | Company Name: ~_ we a mss >a a. aa Accomm namber: 2 WY | WSU Me SOC Y\__ Exp. date: BUY Address: Cosy =) NT Sy 2e+ (Seer RacGmeE o mated) rn City, State and Zip: NGS Nod, meus NOr\ (OOS) | _ Phone number: Guest Information 1. r rr Company: _ renee: I acon nt Confirmation number: Arrival date: ai 29. LOIS Departure date: “= To elt Relation to cardholder: () Relative O) Friend {Business Associate () Other: Room rate:* Taxes:* Total daily rate:* Number of nights: *(Rate and tax amount must be provided by a hotel representative in order to complete this form) WD allchages (©) Roomé& Tax () Telephone (LD) () Telephone(Local) (J Restaurant CJ Room Service () Valet(Laundry) (2) Parking (J HS Internet Access () Movies () Other: | certify that all information is complete and accurate. | hereby authorize THE RITZ-CARLTON CLUB Wo collect payment for all charges as indicated in the Rate Information and Approved Charges section of this form by Processing a charge to the credit card listed above. Charges must not exceed for the entire stay/event. | understand that a new form will have to be completed if guest wishes 0 extend hisher stay. | certify that ] am the authorized signer of the isted above. Cardholder name: crnmes: Cardholder signature: The Redan nel Compe (CRON in ae EFTA00310257