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 anneal The Peninsula Spa at (212) 903-3958 or e-mail it to a THE PENINSULA Gift Card Purchases Recipient (As it will appear on the Gift Certificate): Ee Please Choose ONE of the Services to be Received: Options for Services ONLY: — ([] Include Tax (4.5% NYC Service Tax) LInclude Gratuity Please Note: Prices on all Ceremonies, Retreat Packages and Private Spa Suite Services include an 18% gratuity. OR Additional Information Special Instructions: Total Value of Gift Card: Delivery Method Please note that we do not ship gift certificates via US Mail. 0 Fed Ex Next Day: $35.00 (0 Fed Ex Second Day: $14.00 (0 Own Fed Ex Account Number: Messenger Manhattan Only Not available on weekends C0 $15.00 Messenger 9AM — 5PM Weekdays ONLY (CD $30.00 Messenger After SPM Wekkdays ONLY City, State and Zip: Cardholder Information Name as it appears on the credit card: Type of Card: O) Visa (CO Mastercard [A American Express [[] Discover Account Type: Corporate Company Name: Address (Billing Address): 9 EAST F187r_ ST. City, State and Zip: ew fora VY (2) Phone Number: 212-3520 2 rs _ Fax or Alternate Number: I certify that all information is complete and accurate. I 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. | certify that | am the authorized signer of the credit card listed above. Cardholder Name (Plea Cardholder Signature: EFTA00314153