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Get Hilton Inn at Penn Credit Card Payment Authorization Form

HILTON INN AT PENN Credit Card Payment Authorization Form Please complete all areas below. Incomplete requests may be rejected. This form must be received at least 5 business days prior to the Check-In or by specified date in Event Contract to ensure acceptance of the credit card to be charged. Do not send completed form by email. ATTN FAX COMPLETED FORM TO 215-823-6211 HOTEL USE ONLY Guest / Group Name Date Check-In / Event Date Name of Person/Group Making Reservation Authorized Amount Phone Date Approval Code CARDHOLDER - Please complete the following section and sign/date below. Cardholder Name as it Appears on Credit Card Cardholder Billing Address City State Zip Daytime /Business Telephone Evening Telephone Credit Card Number Expiration Date Credit Card Type Circle one American Express Discover JCB Diners Club Credit Card Issuing Bank Name Bank Phone Number from back of your credit card I agree to cover the following categories of charges Please circle All Charges Room Tax Food Beverage Retail Visa/MasterCard Recreation DIRECT BILL ACCOUNT PAYMENTS ONLY Name on Invoice/Statement Invoice/Statement Number Note Charges for room and tax group deposits or direct bill account payments will be charged to your credit card immediately. Any incidental charges circled above will be charged at the time of check-out. Amount to be immediately charged to credit card for room and taxes or deposit Final Balance Billed to Credit Card hotel use only By signing below you authorize the hotel to charge your credit card immediately for the amount indicated above up to the Maximum Amount indicated above. You further acknowledge that if all charges has been selected then all guest/group related charges less Deposit will be charged to the above card number at the time of check-out or event conclusion* Cardholder Signature. Cardholder Name as it Appears on Credit Card Cardholder Billing Address City State Zip Daytime /Business Telephone Evening Telephone Credit Card Number Expiration Date Credit Card Type Circle one American Express Discover JCB Diners Club Credit Card Issuing Bank Name Bank Phone Number from back of your credit card I agree to cover the following categories of charges Please circle All Charges Room Tax Food Beverage Retail Visa/MasterCard Recreation DIRECT BILL ACCOUNT PAYMENTS ONLY Name on Invoice/Statement Invoice/Statement Number Note Charges for room and tax group deposits or direct bill account payments will be charged to your credit card immediately. Any incidental charges circled above will be charged at the time of check-out. Amount to be immediately charged to credit card for room and taxes or deposit Final Balance Billed to Credit Card hotel use only By signing below you authorize the hotel to charge your credit card immediately for the amount indicated above up to the Maximum Amount indicated above. Any incidental charges circled above will be charged at the time of check-out. Amount to be immediately charged to credit card for room and taxes or deposit Final Balance Billed to Credit Card hotel use only By signing below you authorize the hotel to charge your credit card immediately for the amount indicated above up to the Maximum Amount indicated above. You further acknowledge that if all charges has been selected then all guest/group related charges less Deposit will be charged to the above card number at the time of check-out or event conclusion* Cardholder Signature. .

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