GRAND PALACE HOTEL | @ RIGA - LATVIA Pils strect 12 * Riga * LV 1050 + Latvia www.grandpalaceriga.com CREDIT CARD AUTHORISATION FORM Reserv ation for: Po Reservation from: APR Ens F > O| K Reservation until: BRPKI\C & QO Xs S . > Se Bee P= Reservation Nr. Ii~| Tov Sc 3378078 I authorize “Hotel Grand Palace” Lid street 12, Riga, Latvia, VAT reg. ar. LV400¢ to charge the Bion 00 ona . : N 3 VOC / EUR from the below mentioned credit card for all requested services.* amount of Type of Credit Card: Credit Card Number: Cryptogram number (CVC): Expiry date: Holder’s Name: ssed without a legible front and lfack side copy of the credit-eard—~ is, Holder's signature: ~ —— Date: UARCEL \ |Z oe la Company stamp: (if applicable) est ae THE LEADING HOTELS OF THE WORLD® EFTA00313937