CREDIT CARD AUTHORIZATION FORM Dear Sir / Madam, 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 Rixos Hotel Premium Belek Reservation Department |,___ Jeffrey Epstein , (print your name) authorize Rixos Hotel Premium Belek to apply the charge’s of (print gucst name) re | | __ to my credit card Arrival Date : Ju Ne 31, 501+ Departure Date: JULY + 30)> Approved Charges : Please initial the charges you wish to apply to your credit card. Ail Charges (0 Room & Tax CO Extra Expenses 0) Other _ — Cardholder Information : Name as it appears on the credit card : Jeffrey Epstein — Card Type : BVisa (Master Card Credit Card Number i Exp. Date : 06/2018_ or:987 Address (where statement is mailed) Total Phone number | ti‘(<i‘wd _ Fax number _ 7 E-mail = | certify that all information ts complete and accurate. | hereby authorize Rixos Hotel Premium Belek to collect payment for all charges as indicated in the Rate Information and Approved Charges section of this form by proccessing a charge to the credit card listed above Charges must not exceed fort he entire any event. | understand that a new form will have to be completed if guest wishes to extend his/her stay. I certify that | am authorized signer of the credit card listed abov e Cardholder name : __Jeffrey Epstein EFTA00313730