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HTML Preview Credit Card Authorization Letter page number 1.
1
Credit Card
Authorization Letter
Credit Card
Authorization Letter
I, (print name as appears on card)
authorize the use of m
y
credit card described below for charges related to services pro
vided by the Mosley Motel.
Credit Card T
y
pe :
Visa MasterCard
Credit Card Number:
Expiration Date:
Name of Card Holder:
Signature:
Date:
**NOTE: Must include a cop
y of front and back of the credit card.
The
back of the card must
be signed. **
I understand that the amount charged to m
y credit card will be reflected on my credit card
statement within seven days of authorization. The amount charged is based on services
requested by me.
Signature:
Date:
Billing Zip Code:
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