Guest Name:

Additional Guest:

Check-In Date:

Check-Out Date:

Phone:

Room Type

Bed Type

Special Requests Airport Transfers Requested?

Yes No

Interested in Travel Insurance?

Yes No

Cancellation penalties could be 100% of the cost of your vacation. If you do not purchase Travel Insurance, you are responsible for any cancellation penalties.

Additional Guests:

Cardholder Name as it Appears on Credit Card: Cardholder Billing Address:

City:

State:

Zip:

Daytime/Business Telephone:

Evening Telephone:

Email:

Credit Card Number:

Expiration Date:

Credit Card Type:

CVC CODE:

I agree to cover the following categories of charges:

Deposit only:

Additional Payment:

Final Payment:

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

Yes, please email a copy of the receipt at checkout. E-Mail:

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:

Credit Card Payment Authorization Form

Sign Up For Our Newsletter