Free credit card authorization form template 37Free credit card authorization form template 37
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INSTRUCTIONS:
1) Please call us to confirm room availability and rates.
2) Please fill out this form and fax to COMPANY NAME at (123) 123-4567, along with a photocopy of your
credit card and government issued photo identification (e.g. driver's license or passport). Failure to fill out
this form completely will delay check-in.

Authorization to Charge Credit Card
Cardholder’s Name
Billing Address

Phone
Email
Credit Card #
Expiry Date

Security Code

Room Reservation
Guest Name(s:
Date of Arrival

# of Nights

Room Rate

Total Due ($)

By signing this form, I hereby authorize COMPANY NAME to charge the credit card identified for all charges
associated with the above requested room reservation, including room charges, taxes, and any resulting
damages. I understand and accept that COMPANY NAME has a no refund policy and that the above named
room reservation is non-refundable.

Authorized Signature of Cardholder

Date

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