CREDIT CARD AUTHORIZATION FORM
Name of Guest or Organization ______
Cardholder Name (please print) ______
Cardholder Phone Number ______
Please identify credit card below (check one)
____ American Express ____ MasterCard
____ Carte Blanche ____ Discover
____ Diners Club ____ Visa
____ JCB
Credit Card Account Number: ______Exp. Date ______
Description of services: All Charges ______
Room/Tax ______
Advance Deposit ______
Banquet Functions ______
Other ______
Date of Function:
I hereby authorize the Omni Bedford Springs Resort & Spa to apply costs for the above listed items/services to the credit card identified above.
Cardholder Signature ______Date ______Auth. Code______
Address to which statement and charge voucher to be sent:
Name ______
Company Name ______
Address ______