Instructions

**All information will be kept strictly confidential by the Huntingdon Inn.

NAME ON CREDIT CARD TYPE OF CREDIT CARD  VISA  MC  AMEX  DISCOVER  OTHER

TYPE OF ACCOUNT            PERSONAL                        BUSINESS

COMPANY NAME

ACCOUNT NUMBER                          

EXPIRATION DATE                            

BILLING ADDRESS

CITY

STATE

ZIP CODE

PHONE

EMAIL

FAX NUMBER

NAME

COMPANY

PHONE NUMBER

EMAIL

ADDRESS

IDENTIFICATION

RELATION TO OWNER

TYPE OF CHARGES

AUTHORIZED AMOUNT

DATES OF CHARGES

I certify that I am the authorized holder and signer of the credit card referenced above. I certify that all information above is complete and accurate. I hereby authorize collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the “AUTHORIZED AMOUNT” field. I understand this is only for up to this amount during the time period of “DATES OF CHARGES” referenced above. If additional charges are going to be authorized a new formwill haveto be completed

Card Holder Name :___________________________________

Signature :___________________________________

Date:______________________________________