Credit Card Authorization Form for Events

Dear Guest: We are delighted that you have selected us to host your event. Please provide all the information requested below as a form of payment for your event charges. Please note that your credit card will be charged 5 business days prior to the event. Please fax the completed form to (215) 625-6033, Attention: Billing (Philadelphia Marriott Downtown) Cardholder Information Name as it appears on the credit card: Card type: Account type: Visa MC Amex Diners/CB Discover JCB

Individual (personal credit card) Corporate Company Name: Exp. date:

Credit Card Account Number: Address: (where statement is mailed) City, State and Zip: Phone number: Event Information Name of Event: Organization Name (if applicable): Phone Number: Event Dates: Fax or alternate number: Fax or alternate number:

I certify that all information is complete and accurate. I hereby authorize the Philadelphia Marriott Downtown to collect payment for all authorized charges associated with this event by processing a charge to the credit card listed above. I certify that I am the authorized signer of the credit card listed above. Cardholder name: (Printed) Cardholder signature:
For Hotel Use Only Accounting Log Hotel Representative Initials:__________Date Entered in system:_____________Account number:_____________

Date:

Philadelphia Marriott Downtown