Credit Card Authorization Form

Please print the below form by clicking on the printer icon in the upper right hand corner of this page. Upon completion, please fax to (970) 453-4284.

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:_______________________________________

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 of this form, please fax to 970/453-4284.

Thank you for choosing Beaver Run Resort!