Holiday Inn Credit Card Authorization Form
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Payment Card Authorization Form

Payment Card Authorization Form
Please complete this form in its entirety, include all requested documentation, and fax it to the hotel at least 3 days prior to check­in
to allow for processing. If you have fewer than 3 days before the check­in date, please call the hotel for instructions. This Payment
Card Authorization Form is valid for the individual reservation(s) listed below.
Today's Date: _________________
I, _______________________ authorize use of my payment card for FULL PAYMENT of the following:

Room & Tax

Incidentals

Banquet Charges

Other __________________________________

This reservation will be guaranteed to the payment card provided. In the event of a no­show, the payment card will be charged
Room & Tax.

Guest Name
Company
Address
Telephone/Fax

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)

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1.

2.

3.

4.

)

Confirmation Numbers

Arrival Date
Number of Nights

Payment Card Number
Expiration Date
Name on Card

Billing Address

Telephone/Fax

(

)

(

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Cardholder Sig