CREDIT CARD AUTHORIZATION FORM Individual/Business/Group or Event Name: ie Reservation Confirmation Number: SC anatertventdates: [FER ¥- 1D Ss~—~S Credincard siting address [F CacT Fis ST AYN lO0al City / State / Zip / Country / Region: e€ YORK IY 1OO2 | 4 in. oa *A valid telephone number and email are required as we will need to contact you to confirm receipt. If we are unable to do so, your reservation will be subject to cancellation. thereby authorize the following charges to be applied to the following credit card. Check all that apply: Room & All Applicable Taxes [1] Gift Certificate [ZAI Stay Charges [Food & Beverage C] Only Specific incidentals [7] All Banquet Charges [7] Guest Amenity | [ZAI incidentals [Resort Services Fee (7) Parking 7) Other - see comments | thereby authorize the following amount be applied to the credit card (applicable sales tax and service charges may apply): F/©00. 60 “In Australia: An additional service fee will apply to the total stay account when paying by AMEX, Diners and ail other credit cards upon departure. Refer to the hotel's website for more details. * The credit card listed below may be billed for the estimated charges Ten (10) days prior to event/reservation date. *Room and tax on individual bookings will be charged 72 hours in advance. eratnoae [Cf ii ee a Signature of Card Holder: Current Date: (Fes, 5, 2014 ny * Hotel reserves the right to refuse a credit card authorization ada ‘alid of payment for same day bookings or authorization rh By submitting this form and any supporting documents, | cdbfftm that | have read and agreed to the use of the personal information lam giving you in accordance with your Global Privacy Policy for Guests, which is available at Privacy.hyatt.com Please fax this completed form to: Hotel Fax #: |.) For a list of all hotels and their contact information, please visit: hittpsy/www.hyatt.com/hyatt/site-map jsp All information is kept confidential and used only for the purposes as noted above. EFTA00313988