¥ RIXOS 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 lease fax the completed form to Rixos Hotel Premium Belek Reservation Departmen A Jeffrey Epstein _, (print your name) authorize Rixos Hotel Premium Belek to _apply the charge’s of (print guest name) F and || to my credit card Arrival Date June 21, 501+ Departure Date: ) ULY 4 30)5 =~ +t Approved Charges : Please initial the charges you wish to apply to your credit card. rail Charges [) Room & Tax [] Extra Expenses C) Other Cardholder Information : Name as it appears on the credit card : Jeffrey Epstein AVisa CJ Master Card Credit Card Number Po = Exp. Date : 06/2018 Card Ty r:987 Address : Where statement is mailed) Total: “0 By Phone number Fax number Il 4548 | certify that all information 1s 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 évent. | understand that a new form will have to be completed if guest wishes to extend his/her stay I certify that I am authorized signer of the credit card listed above Cardholder name Jeffrey Epstein_ EFTA00313739