Fell 0 MI E S tit I lr n S 13 lr I-4 I L- T ICI 11,4 Address: 105 Hospitality Drive, Plowood, MS 39232 In lieu of my credit card imprint, I authorize Credit Card Authorization Form C*-PE-TG hereby (Print name of cardholder as shown on card) m &- lc A,-) G.--MVE57 Carla el 0/3 tocharge my AtueRACtiN1 eg-pgsics (Credit Card Type) (Expiration Date) for payment of accommodations for myself and/or II G4-7-931 Ouulne rarrierritrauol arrant'. name) (Credit Card Number) in me amount of $ 11200. O a (Include total for rooms and tax) &OtJ (Full name of guest (s) If other than cardholder) Confirmation Number (s)) lb of Rooms 1— Rate ta3. '9 ' Tax ,/ Other / *(t Total ),o0 Check in Date Check Out Date at-i "SAni 30;;; I SAN( My Credit Card Address: Office ft: Email A ress: By signing below I acknowledge charges described cc nem. Payment In full to bo made when billed or in extended payments In accordance rd aelky of COT ny issuing the credit card in the event the hotel is required to issue a refund or credit, a 5% merchan will be • cted f e total amount. r )c0' ' a--ra e l ure of holder) (Date) LJ Place front of Credit Card 0 t 9 EFTA00313980