Huntingdon Inn Motel
13930 Route 30 North Huntingdon, Pa 15642
Office: 1 724 863 5630
Fax: 1 724 863 5630
Credit Card Authorization Form
13930 ROUTE 30 NORTH HUNTINGDON, PA 15642
1. Print and complete the form legibly in dark pen.
2. Sign with credit card holder’s signature in the assigned line below.
3. Include a photocopy of the a driving license.
**All information will be kept strictly confidential by the Huntingdon Inn.
CREDIT CARDHOLDER INFORMATION
NAME ON CREDIT CARD TYPE OF CREDIT CARD VISA MC AMEX DISCOVER OTHER
TYPE OF ACCOUNT PERSONAL BUSINESS
AUTHORIZED USER OF CREDIT CARD
RELATION TO OWNER
TYPE OF CHARGES
DATES OF CHARGES
AUTHORIZATION OF CARD USE
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 :___________________________________