etb MANDARIN ORIENTAL NEW YORK ma 3rd PARTY CREDIT CARD AUTHORIZATION GUEST NAME: VA-r 1-12/•i rztigmkALE.- C, FROM: Z-e -r:t7-(ze-‘1 G2sTE.INI TREATMENT: Deep T►SSue. MA SPA4-% E DATE OF TREATMENT: FEYS . 13 TIME OF TREATMENT: I: I hereby authorize Mandarin Oriental, New York to charge my credit card for the charges indicated below for the above guest: Cardholder Last Name L7P c.'Tel NJ Cardholders First Name ...) etirf bragExp. Date 1//1-li ❑ JCB 0 Discover Credit Card a lErAmer ❑ VS MasterCard Diners Billing Address q G-Ast 1r-- g-rieGar City E tj x to State N .! zipIOO?} Country Lt s A Telephone Fax Email Amount $ .5-0 j) 0 • Approval Codes Item purchased [also, state quantity]: I assume respo ibility for a &TM. Please sign Kindly fax to (2 e attention of Mandarin Oriental. New York Spa Please check off the following: for Office Use only: o Copy for Guest Processed by: Date: o Copy for Spa n copy for Finance (1W) EFTA00313847