FIRENZE CREDIT CARD AUTHORIZATION FORM Credit Card Type 4 M E X Credit Card nee Expiry Date G/i2 | Name of Cardholder__ J € FFREN EPSsSTE iA) Address where statement of account is mailed: street_7 EAST H*_ StrReer city New YoR<e State N / Country USA | authorize Relais Piazza Signoria to charge for my reservation the above credit card number for the amount of€uro FQ OO ELROS checkin NOV. “E. - Check-out... NOV... F a0Kr Total nights are 34. Total amount is €uro This reservation cannot be canceled. Cardholder signaturi Relais Piazza Signoria Via Vacchereccia, 3 50122 Firenze Tel. #39055 3987239 Fax +39055 286306 PT ey EFTA00314079