Hilton Credit Card Authorization Form
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Credit Card Payment Authorization Form
Do not send completed form by email.
FAX COMPLETED FORM TO:

ATTN:

Date:
HOTEL USE ONLY:
Guest / Group Name:
Check-In / Event Date:
Name of Person/Group Making Reservation:
Authorized Amount:

Phone:
Date:

Approval Code:

CARDHOLDER - Please complete the following section and sign/date below.
Cardholder Name as it Appears on Credit Card:
Cardholder Billing Address:
City:

State:

Zip:
Evening Telephone:

Daytime /Business Telephone:

Credit Card Number:
Expiration Date:
Credit Card Type: (Check one)
☐ Visa
☐ MasterCard
☐ American Express
☐ Discover
☐ JCB
☐ Diners Club
Credit Card Issuing Bank Name: _____________ Bank Security Number (from back of your credit card): _______________________
I agree to cover the following categories of charges: (Please check)
☐ All Charges
☐ Room & Tax

☐ Food & Beverage

☐ Retail

☐ Recreation

I agree to cover the above categories of charges up to a Maximum Amount of $

Note: Charges for room and tax, group depos