Third Party Credit Card Authorization Form

Contact Person *

First Name

Last Name

Phone

(###)

###

####

Name on Credit Card *

First Name

Last Name

Credit Card Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guest #1 *

First Name

Last Name

Guest #2 *

Complete if a 2nd room is required for the same dates. If only one room is required, insert n/a in the name fields below.

First Name

Last Name

Check In Date *

MM

DD

YYYY

Check Out Date *

MM

DD

YYYY

I authorize The Clairestone Inn to charge my credit card for the following charges related to the stay of guest(s) outlined above: *

Room + Taxes

Incidental Charges

Damages (if not selected, the guest(s) will need to provide a personal credit card upon check in. A $100 pre-authorization will be processed.)

Cardholder Signature: *

First Name

Last Name

Date

MM

DD

YYYY