Gift Certificate Authorization Form This form has been created in order to allow you to have third party expenses charged to your credit card. Please provide all the information requested below to ensure prompt processing. We ask that you either fax this completed form to The Peninsula Spa at (212) 903-3958 or e-mail it t " THE PENINSULA Gift Card Purchases Recipient (As it will appear on the Gift Certificate): Melanie Spinella Please Choose ONE of the following options: Services to be Received: Options for Services ONLY: _ ((] Include Tax (4.5% NYC Service Tax) Dinclude Gratuity Please Note: Prices on all Ceremonies, Retreat Packages and Private Spa Suite Services include an 18% gratuity. OR Flat Monetary Amount: Additional Information Special Instructions: Total Value of Gift Card: $2000.00 Delivery Method Please note that we do not ship gift certificates via US Mail. 4 Pick ~ Up at Spa Reception No Charge FedEx 0 Fed Ex Next Day: $35.00 CO Fed Ex Second Day: $14.00 O Own Fed Ex Account Number: Se Ne | Urn AEE] | Messenger Manhattan Only Not available on weekends 0 $15.00 Messenger 9AM ~ SPM Weekdays ONLY C) $30.00 Messenger After SPM Wekkdays ONLY Ship to: OO Recipient 0 Purchaser OO) Third Party City, State and Zip: Cardholder Information Name as it appears on the credit card: Jeffrey Epstein Type of Card: 0 Visa CO Mastercard += [¥] American Express [] Discover Account Type: bi F CO Corporate — Company Name: Account Number: Exp. Date: ¥/ / i Address (Billing Address): gS Ee AST Es ) fr St City, State and Zip: New yoeK NIM (OOS) Phone Number: 213-350-9993 — Fax or Alternate Number: | certify that all information is complete and accurate. | hereby authorize The Peninsula Spa, New York to collect payment for all charges as indicated on this form by processing a charge to the credit card listed above. I certify that I am the authorized signer of the credit card listed above. Please note that we require a handwritten Signature in order to process this order. Cardholder Name (Please prifi): “WerFrRey ec PSTE wl Cardholder Signature: EFTA00314151