ROCCO FORTE HOTELS SF CREDIT CARD AUTHORISATION FORM Cornauienue 06 onnate Please complete and fax the form to - Toxaayiicra, 3anonnnre AanHyw hopmy Hu oTnpassre eé no daxc Or alternatively email to the following dedicated email address - Han ornpannte Ha saektpounyiw noyty: | will be responsible for charges to the value of / A Paspewaw CHATS C Moe KapTe! CyMMy 8 pasmepe : BYOCO RUS 3a ycaym, : Single event /EpnrospemexHo ) 3) Monthly /Exxemecauno [x] Annually /Exeroguo a Other/Dpyroe O Please specify/Nomanyiicta, noacuurTe I wish the charges incurred on the above account(s) to be settled in the following manner: A pa3pemaw npousrectH cHaTHe ,eHEXxXHDIX CPpeACTs cneayiouyM o6pazom: Credit Card Type: THN KpeAMTHOR kapre: Credit Card Number: Homep KpeanTHom Kaprol: Credit Card Expiry Date: Kapta aeicrentenbua fo: Issue Number (for Maestro only): Homep spinycxa: (TonbKo Ana Kap Maestro) Start date (for Maestro only): Kapta Aehcreutenbxa c: TOADKO ANA KapT Maestro) i i = —= Card Holder Signature: Noannce pepmatena kapTer: ro eo PAREINOPESEeEuNoooooo G EAST FIST Strpeer NEW yoer, oods2 Date/fata: Statement Address for Credit Card / Anpec npomneanna Contact Telephone Number / KOnTaKTHbMm Tenedon Proof of card holder’s identification may be required with this form (Passport) / K AanHoli dope Moxert noTpe6oraTica NPHAOAKTE KONKW AOKYMeHTa, YAOCTOBepAloMero AM4HOCTS AepxaTera (nacnoprT) Full Card Number / Homep kaprei: Credit Card Expiry Date / OL > O>\ Kapra nevictentenbHa fo: EFTA00314070