Marriott Credit Card Authorization FormMarriott Credit Card Authorization Form
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Dear Sir/Madam,
This form has been created in order to allow you to have third party expenses charged to your credit/debit card. Please
provide all the information requested below to ensure prompt processing of your application. We ask you to please sign and
date the form before submission. Please fax the completed form to the hotel. The hotel fax number can be found on the hotel’s
website. Do not send photocopy of the front or back of the credit card with this form, as this is against credit card company
regulations.
Cardholder Information - Required
Name as it appears on the credit/debit card:
Card type:

Visa

Account type:

Personal

MC

Amex

Diners/CB

Discover

JCB

Corporate | Company Name:

Issuing Bank:

Phone #:

Account number:

Exp. Date:

Address:
(wh ere statement is mailed)

City, State and Zip:
Phone number:

Fax or alternate number:

Guest Information - Required
Guest name:
Address:
City, State and Zip:
Company:
Phone number:

Fax or alternate number:

Confirmation

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