THIRD PARTY CREDIT CARD AUTHORIZATION FORM

I, (please print) ___________Saddiq granger________________, authorize WHG ES, Inc. to charge

the credit card provided below as payment for one of the following:

(Please place initials beside the item you agree to pay)

A) __yes______ Room and Tax ONLY (Guest pays ALL other charges)
B) ________ Room, Tax, Phone, and Fax Charges (Movies and Games are blocked)
C) ________ ALL Charges (Room, Tax, In-Room Safe, Phone, Fax, Movies and Games, etc.)
D) ________ Amount ($) __________________ (Guest pays any remaining balance)

Name as it Appears on Credit Card: _______________Saddiq

granger____________________________________

Company Name (if applicable): _______________________________________________________

Type of Card: __________________debit mastercard____________ Expiration Date:

__________________12/19_______

Card Number: _______________________5172780021841497_____________________V-

Code_________________

Credit Card Billing Address: ______________916 n 16th

____________________________________________

City: ___________________________waco_________ State: __tx_______ Zip:

__________________76708____

Guest Name(s): _______________john

honea____________________________________________________
(Attach list if more space is required)

Arrival Date: _______________6/4/2017_____________ Departure Date:

________________6/5/2017____________

Confirmation Number(s): 67346ab010369

Contact Telephone:
__________________________2675796618______________________________________

Cardholder Signature: ____________________Saddiq granger____________________ Date:

_________________
Please provide a Front & Back copy of the Credit Card and a
copy of the Card Holders State Issued DL.
Please Fax with completed form to: (512) 331-1166
Property/Corporate Use Only
Reg. Card Number:

Revised: June 11, 2010

 Folio Number:

Invoice Number(s):
Amount Paid:
Date Processed:
Processed By:

Revised: June 11, 2010