AUTHORIZATION FORM

AUTHORIZATION FORM Please fill out and sign the Authorization form in printed letters, attach passport copy, the credit card copy of both sides, and bank confirmation with the stamp that the card belongs to the person signing the agreement, send the whole file to the attention of the Reservation department: rtstn ati mu.. a stanclartliottl.com Date Address TelAFax E-mail address Topic I tetchy, I Jut-i }-, 301 ci C- AS -r "31 Si Sr. NI `) I I Crean t_am guarantee Jr i 2e-‘1 ?SS The card holder first and last name carc Authorize the payment of with my credit i %o' Pavrneht for: EtAll expenses 0 Pay TV 9 SPA 0 Accommodation incl VAT K Telephone Taxi K Breakfast K Laundry'Dty cleaning El Other expenses During the period of stay sj t_fL>j I Arrived date For MrAMrs. Reservation No Signature Sincerely, Reservations rAinr'4,44" r ca0 1,? Departure date the c Amount Date ,17" t.4 c t ,3 oIF? EFTA00313907