II] DORAL INN & SUITES Third Party Credit Card Authorization Form required This form to has accept been created this form in order and to allow you to have third party expenses charged to your credit/debit card. I understand that the hotel is not the guest should check with the hotel to ensure they accept third part transactions. Please provide all the Please information fax the requested completed below to ensure prompt processing of your application. We ask you to please sign and date the form before submission. form to Doral Inn and Suites Miami Airport West at (305) 429 8754 FOR credit SECURITY card holder reasons. purchase Doral a gift Inn card and Suites conforms to all Payment Card Industry (PCI) standards. However, we recommend that the for the guest(if possible) rather than send their credit card number via this third party form. CARDHOLDER INFORMATION - Required Name as it appears on the credit/debit card: Card Type: Account Type: Issuing Bank: Account Number: Address (statement): City, State, Zip: Phone Number. JER-ciac-s•I G €-,-ps-rel,.1 El Visa El MC laikmex 0 Diners/CB 0 Discover Fax or Alternate Numbe GUEST INFORMATIONGuest Name: Address: City, State, Zip: Company: Phone Number: Confirmation Number: - 0 Debit / 0 Credit C-;i24CA 0 Corporate - Company Name: Phone: Exp. Date: gal 0 JCS Relation to Cardholder: 0 Relative Fax or Alternate Number: Arrival Date: TAr.1 3, a5::)11 Departure Date: Tpvti . apt& agend 0 Business Associate 0 Other during understand my stay. that Departure should there date be cannot any issues with the credit/debit card being used to settle my charges. I will be responsible for all expenses incurred be extended unless a new authorization form is completed. Guest Name: (Printed) Guest Signature: RATE INFORMATION AND APPROVED CHARGES - Required Room Rate:* tc,S) , as Taxes:* Total Daily Rate:* *(Rate and tax amount must be provided by a hotel representative in order to complete this form.) ErAll Charges 0 Room & Tax ❑ Telephone (LD) 0 Telephone (Local) 0 Room Service 0 Other Date: 0 Valet/Laundry 0 Parking El HS Internet Access Number of Nights: ID Restaurant 0 Movies as I certify indicated that in all the information Rate is complete and accurate. I hereby authorize Doral Inn and Suites Miami Airport West to collect payment for all charges must not exceed $5,000 Information for and Approved Charges section of this form by processing a charge to the credit/debit card listed above. Charges certify that I am the authorized the signer entire of stay/event. I understand that a new form will have to be completed if guest wishes to extend his/her stay. I the credit/debit card listed above. Cardholder Name: (Printed) Cardholder Signature: r Date: SSAdaaae_ r-P-6 GPSTFirJ 1212 NW Please do no s nd a photocopy of the front or back of your credit card. 82" Avenue. Miami FL 331261 P : (305) 629 8755 / FAX (305) 629 8754 / MAW docalmnandsuites.com /email: cloralinneolsolesegmailcan EFTA00313800