CTIMID.FIPT:g o..,.,(, COOMICILLS AUTHORIZATION FORM Please fill out and sign the Authorization form in printed letters, attach passport copy, the credit card cop of both sides, and bank confirmation with the stamp that the card belongs to the person signing the agreement, send the whole file to the attention of the Reservation department: Date Address TeISFax E-mail address Topic or: Credit Card guarantee Hereby, I The card holder first and last name Authorize the payment of with my credit card Credit Card number expiry date Payment for: 0 All expenses 0 Pay TV 0 Accommodation incl VAT 0 Telephone 0 Breakfast 0 Laundrylly cleaning During the period of stay For Mr.1Mrs. O SPA O Taxi 0 Other expenses Arrival date Departure date Reservation No Signature the card holder Sincerely, Reservations Amount Date Sa 25009 EFTA00293607