Credit Card Authorization Form

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    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    *THE NAME ON THE ABOVE CREDIT CARD MUST MATCH THE NAME OF THE PERSON AUTHORIZING CHARGES.

    YOU MUST FAX OR EMAIL A COPY OF THE ABOVE MENTIONED CREDIT CARD – BOTH FRONT AND BACK. PLEASE INCLUDE COPY OF VALID ID (DRIVER’S LICENSE, STATE ID, OR PASSPORT) PLEASE FILL OUT & FAX OR MAIL THIS FORM ALONG WITH A PHYSICAL COPY OF THE ACTUAL CREDIT CARD **PLEASE MAKE SURE TO FILL IN THE FORM COMPLETELY. TYPING YOUR NAME IN THE BELOW BOX WILL BE CONSIDERED A LEGAL SIGNATURE. In lieu of my credit card imprint, I hereby authorize The Greystone Motel or their representative to charge my above Credit Card for the agreed upon amount given by Greystone Motel Employee/Manager or any amount for one-time or future transaction. By signing below, I acknowledge the charges described above. I understand the above amount is subject to cancellation policies and rules and regulation of The Greystone Motel which have been understood by me and undertake not to take a charge back.