HOME Ss vuvuitTe s& - te HRintcrom Address: 105 Hospitality Drive, Flowood, MS 39232 Po Credit Card Authorization Form in liew of my credit card imprint, | hereby {Print name of cardholder as shown on card) authorize AMeRIC An Expeess CaNru #) Onto charge my AMERICA| = YRRE S eid Te) (Credit Card Type) . 2 | > (Credit Card Number) (Expiration Date) in the amount of $ 2) OD for payment of accommodations for myself and/or hs (include total for rooms and tax) . vs Eu €2yY POvEOs] mk sinmtasaialll (1O4F93)\ _ (Full name of guest (s) if other than cardholder) (Confirmation Number (s}) My Credit Card Address: _ 2 Office # Email Address: Ses A ee By signing below | acknowledge charges described on here, Payment in full to be made when billed or in extended payments in accordance withstandard policy of company issuing the credit card in the event the hotel is required to issue a refund or credit, 25% merchany tee will be cred = total amount. C/__ (Bate) Place back of Credit Card ture of holder) Place front of Credit Card EFTA00313980