Credit Card Authorization Form

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I, the undersigned, authorize the Beaver Run Resort and Conference Center to use the specified credit card as payment for the following charges…

__________________________________________________________
Print Name on Card

Organization/Company Name: _____________________________________

Account#_________________________________Expiration __/__

 

Cardholder’s Signature

Billing Contact Phone #____________________________________

Conference Name:________________________________________

Reservation Number:_____________________________________

Name on Reservation:_____________________________________

 

Arrival Date: _____________ Departure Date: __________________

Please check all that apply:
Food & Beverage $_______________
Meeting Room Rental and Audio Visual Requirements $_______________
Guest Room and Tax Only  $_______________
Guest Room Charges Including Incidentals $_______________
Other ___________________ $_______________

Upon completion on this form, please fax to 970/453-7234.

Thank you for choosing Beaver Run Resort!


Upon receipt of this form, we reserve the right to charge applicable fees to this card at any time.


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