EURODYN 2017

To be signed and sent to

Mrs. Simona Filippi – Phone +39 0644875220 mail: - Fax number +39 064457205.

Authorization form for credit card debit

Credit cards which do not belong to the Client (or to his legal representative) will not be accepted.

By signing the present form, Client declares to be the holder of the credit card below mentioned.

Guest name: ______

Hereby I authorize the BEST WESTERN Plus Hotel Universo to guarantee on the credit card shown below the booking in reference, and to charge for late cancellation or no show:

Check in 10th of September 2017Check out 13th of September 2017

ᴏ N° _____Single Room Euro 143,00 per room per night

ᴏ N° _____Double Room for single useEuro 151,00 per room per night

ᴏ N° _____Double RoomEuro 166,00 per room per night

The rates are intended per room per night and are inclusive of service, buffet breakfast and 10% VAT

The tourist accommodation tax are not included in the rate and is 6 Euro per person per night for up to 10 consecutive nights (excluding children under 10) to be paid directly at the hotel's reception desk when you check out.

Cancellation policy: free cancellation up to 3 days prior to arrival. Payment in hotel.

One night of penalty will be charged on your credit card in case of late cancellations or no-show.

We kindly inform you that no rooms are been blocked it will procced on request according to our availability.

Credit card:

o VISA o MASTERCARD o DINERS CLUBo ______

Credit card holder’s name ______

number ______Expiration date ______

Address for the invoice ______

Credit card holder’s telephone number ______

Hereby I declare to be the official authorized person for the payment of the booking shown above.

I authorize you to treat my personal data exclusively for the purpose indicated in the present form, in compliance with the Art. 13 d.lgs 196/2003.

I hereby declare that all the information is accurate and complete.

PRIVACY AND SECURITY POLICIES

I authorize you to treat all personal data for the above-mentioned purposes, in compliance with Art. 13 of law 196/2003.

Roscioli Hotels Roma ensures the highest level of safety in the management of user data. The credit card information is stored in compliance with the safety requirements laid down by standard PCI - DSS (Payment Card Industry - Data Security Standard).

Roscioli Hotels Roma has no access to the confidential data concerning credit cards, which will be treated by the intermediary and by the credit cards companies according to the Security Standards and to the Privacy Laws.

Signature ______Date ______