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Third Party Credit Card Authorization Form: Cardholder Information - Required

The Third Party Credit Card Authorization Form allows third-party expenses to be charged to a credit/debit card for hotel stays, requiring the completion of specific information and signatures. It emphasizes the importance of confirming acceptance by the hotel and recommends using a gift card for security reasons. The form includes sections for cardholder and guest information, approved charges, and a certification of accuracy and authorization for payment processing.

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85 views1 page

Third Party Credit Card Authorization Form: Cardholder Information - Required

The Third Party Credit Card Authorization Form allows third-party expenses to be charged to a credit/debit card for hotel stays, requiring the completion of specific information and signatures. It emphasizes the importance of confirming acceptance by the hotel and recommends using a gift card for security reasons. The form includes sections for cardholder and guest information, approved charges, and a certification of accuracy and authorization for payment processing.

Uploaded by

res
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Third Party Credit Card Authorization Form

This form has been created in order to allow you to have third party expenses charged to your credit/debit card. I understand that the hotel is not
required to accept this form and the guest should check with the hotel to ensure they accept third part transactions. (+ 39 02 48521) 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 send the completed form to [email protected].

FOR SECURITY reasons, Marriott International conforms to all Payment Card Industry (PCI) standards. However, we recommend that
the credit card holder purchase a gift card for the guest (if possible) rather than send their credit card number via this third-party form.

CARDHOLDER INFORMATION - Required DAN OSTERER


Name as it appears on the credit/debit card:
Card Type: Visa MC Amex
Account Type: Individual - Debit / Credit Corporate - Company Name: PTC
Issuing Bank: BEINLEUMI Phone:
Account Number: 5556500350158792 Exp. Date: 03/31
Address (statement): ITZACH RABIN 33
City, State, Zip: GIVATAYIM, ISRAEL
Phone Number: +972303031010 Fax or Alternate Number:

GUEST INFORMATION - Required


Guest Name: OVADIA AMIT & EINHORN AHARON & VAQUER LEVIN FERNANDO EUGENIO
Address:
City, State, Zip:
Company:
Phone Number: Fax or Alternate Number:
Confirmation Number: 80474830 + 80471087 + 80471095 Arrival Date: 28/03 Departure Date: 30/03
Relation to Cardholder: Relative Friend Business Associate Other

I understand that should there be any issues with the credit/debit card being used to settle my charges, I will be responsible for all expenses incurred
during my stay. Departure date cannot be extended unless a new authorization form is completed.

Guest Name: (Printed) OVADIA AMIT & EINHORN AHARON & VAQUER LEVIN FERNANDO EUGENIO
Guest Signature: Date: 27/03/25

RATE INFORMATION AND APPROVED CHARGES - Required


Room Rate:* 22 EUR Taxes:* Total Daily Rate:* 88 EUR Number of Nights: 2
*(Rate and tax amount must be provided by a hotel representative in order to complete this form.)
All Charges Room & Tax Telephone (LD) Telephone (Local) Restaurant
Room Service Valet/Laundry Parking HS Internet Access Movies
Other breakfast, € 22.00 per person per day

I certify that all information is complete and accurate. I hereby authorize Milan Marriott Hotel to collect payment for all charges as indicated in the
Rate Information and Approved Charges section of this form by processing a charge to the credit/debit card listed above. Charges must not exceed
€__ 88 __ for the entire stay/event. I understand that a new form will have to be completed if guest wishes to extend his/her stay. I certify that I
am the authorized signer of the credit/debit card listed above.

Cardholder Name: (Printed) DAN OSTERER


Cardholder Signature: Date: 27/03/25

Please do not send a photocopy of the front or back of your credit card.

Marriott Confidential and Proprietary Information

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