Credit Card Authorization Form

Personal Information

First name Middle Last name Check-In Date

Check-Out Date Person Checking In

Address City State Zip code

Home phone Cell phone E-mail address

Driver's License # State License Issued at

I hereby authorize The Bungalows Hotel & Event Center to charge my credit Card as follows:

Name on Card

Credit Card Type Credit Card Number Expiration Date

3 or 4 Digit CVV2 Number Do you want this charge to be One Time or Recurring Charge?

Amount Incidental & Other Charges may Apply.

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge.

Signature Date