PULLMAN RIGA OW TOWN HOTEL 24 JEKARA STR. LV-1050 RIGA LATVIA +371 67815444 H9619@accor.com PULLMANNOTELS.COM ACCORHOTELS.COM AUTHORISATION TO CHARGE MY CREDIT CARD ACCOUNT Room reservation conformation Nr. Name (as It appears on card): Card type (please check): n 111 Card number: Expiry date: VISA Mastercard / Eurocard Maestro aol P By credit signing card this form, I authorize Hotel Pullman Riga Old Town to charge my account with the following amount: (currency) LA Lt....A eiS (amount) t liOO. 4" for (description of the services purchased; confirmation/invoice number): IQD Dik-4 Date: NOV II Q01 -4-- Place of signing: Signature of cardholder: Completed authorization form should be :d to: H9619@accor.com +371 67815444 Contact erson handl' okings: AME,c Ce4-nAR.rvt-i t -E-7- --?•4-±- Please keep a copy of this form for your own records! EFTA00313771