Marriott. HOTELS & RESORTS Credit Card Authorization Form Dear Sir/Madam, This form has been created in order to allow you to have third party expenses charged to your credit/debit 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 340at 7156193 Cardholder Information - Required - Name as it appears on the credit/debit card: l nl a ES Card type: CO vise (J mc [7 Amex [] DinersiCB ( Discover [J JCB Account type [Personal C] Corporate Company Name NOAA! (5 ve — Issuing Bank Phone # __ Exp. Date: | Fax or alternate number Account number Address: (where satereet is rasiee) t City, State and Zip: : | looD\ Phone number Guest Information - Required Guest name: Address: City, State and Zip: Company: Confirmation number is 2 | XC] Arrival date MAY Ye. DO l>* Departure date: MAY ©}, QOIF = Relation to cardholder C) Relative (] Friend EY Business Associate ["] Other | understand that should there be any issues with the credit/debit card being used to settle my charges, | will be responsible for all expenses incurred during my stay. Departure date cannot be extended unless a new authorization form is completed Guest name: (Paneth Guest signature: Date Rate Information and Approved Charges - Required Room rate:* 4/4 ©° Taxes:* —_ Total daily rate:* Number of nights; _/- =_— *(Rate and tax amount must be provided by a hotel representative in order to complete this form) “All Charges (CD Room & Tax (CF Telephone(LD) —[[] Telephone (Loca!) () Restaurant (-] Room Service [7] Valet (Laundry) (_] Parking () HS Internet Access () Movies (J Other: | certify that all information is complete and accurate. | hereby authorize Frenchman's Reef & Morning Star Marriott Beach Resort to 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/debit card listed above. Charges must not exceed _ lor the entire stay/event. | understand that @ new form will have to be completed if guest wishes to extend his‘her stay. | certify that I am the authorized signer of the credit/debit card listed above Cardholder name: (Pemnea > QUIF Cardholder signature. ‘ = Date: uM AY Paks EFTA00313728