Credit Card Payment Authorization Form

Please complete all areas below. Incomplete requests may be rejected.

Please FAX COMPLETED FORM TO: 866-258-0768

CARDHOLDER - Please complete the following section and sign/date below.

I agree to cover the following categories of charges:
$
$
$

Note: Any incidental charges will be charged at the time of check-out.

By signing below, you authorize the supplier to charge your credit card immediately for the amount indicated above up to the “Maximum Amount” indicated above. You further acknowledge that if “all charges” has been selected, then all guest/group related charges (less Deposit) will be charged to the above card number at the time of check-out or event conclusion.


Print Name:


Signature:


Date: