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Credit Card Authorization Form

This document is a credit card authorization form for Ibis Styles Bali Kuta Circle hotel. It authorizes the hotel to charge a guest's credit card for their stay. The form requests information such as the guest's name, dates of stay, amount to be charged in Indonesian Rupiah, credit card number and expiration date, cardholder name and signature. It also provides the hotel's contact information and notifies that credit card payments will be charged in local currency according to Indonesian law.

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Putu Buda
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776 views2 pages

Credit Card Authorization Form

This document is a credit card authorization form for Ibis Styles Bali Kuta Circle hotel. It authorizes the hotel to charge a guest's credit card for their stay. The form requests information such as the guest's name, dates of stay, amount to be charged in Indonesian Rupiah, credit card number and expiration date, cardholder name and signature. It also provides the hotel's contact information and notifies that credit card payments will be charged in local currency according to Indonesian law.

Uploaded by

Putu Buda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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IBIS STYLES BALI KUTA CIRCLE

Address : Jl. Bypass Ngurah Rai – Simpang Dewa Ruci No. 99 , Kuta – Bali 80362
Phone : 0361 – 8948999
Fax : 0361-8948555

CREDIT CARD AUTHORIZATION FORM Date :

This letter authorized Ibis Styles Bali Kuta Circle to charges the following Credit Card :

Name of Guest / Group :


Period of Stay :

I hereby, agree to be personally liable for the full statement of charges, as specified :

IDR (Indonesian Rupiah) Amount : IDR.

Please charges the above amount to my Credit Card is as follows :

Credit Card Type


(Amex, BCA, Diners, JCB,Master,Visa) : _______________________________________

Credit Card Number


: _______________________________________

Expired Date
(xx/xx) : _______________________________________

Card Holder Name : _______________________________________

Card Holder Signature : :

I agree that this agreement is irrevocable

Name : _____________________________________

Mailing address : _______________________________________

E-mail address : _______________________________________

Phone Number : _______________________________________

Fax Number : _______________________________________

According the Indonesian Law, the settlement by credit card is charges by local currency (IDR)
The hotels take no responsibility for subsequent exchange rate used by credit card company after check out.

Please kindly attach the copy of Credit Card & Identity Card of the Card Holder
and send back to the hotels
By Fax to : Reservation (Sales Department ) : +62-361-8948555
By E-mail to : Reservation (Sales Department) : H8118-re1@accor.com
IBIS STYLES BALI KUTA CIRCLE
Address : Jl. Bypass Ngurah Rai – Simpang Dewa Ruci No. 99 , Kuta – Bali 80362
Phone : 0361 – 8948999
Fax : 0361-8948555

CREDIT CARD AUTHORIZATION FORM Date :

This letter authorized Ibis Styles Bali Kuta Circle to charges the following Credit Card :

Name of Guest / Group :


Period of Stay :

I hereby, agree to be personally liable for the full statement of charges, as specified :

IDR (Indonesian Rupiah) Amount : IDR.

Please charges the above amount to my Credit Card is as follows :

Credit Card Type


(Amex, BCA, Diners, JCB,Master,Visa) : _______________________________________

Credit Card Number


: _______________________________________

Expired Date
(xx/xx) : _______________________________________

Card Holder Name : _______________________________________

Card Holder Signature : :

I agree that this agreement is irrevocable

Name : _____________________________________

Mailing address : _______________________________________

E-mail address : _______________________________________

Phone Number : _______________________________________

Fax Number : _______________________________________

According the Indonesian Law, the settlement by credit card is charges by local currency (IDR)
The hotels take no responsibility for subsequent exchange rate used by credit card company after check out.

Please kindly attach the copy of Credit Card & Identity Card of the Card Holder
and send back to the hotels
By Fax to : Reservation (Sales Department ) : +62-361-8948555
By E-mail to : Reservation (Sales Department) : H8118-re1@accor.com

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