GRAND PALACE HOTEL Reservation for: Reservation from: Reservation until: Reservation Nr. RIGA - LATVIA Pits street 12 • Riga • LV 1050 • Latvia www.grandpalaceriga.com CREDIT CARD AUTHORISATION FORM I authorize Wad Grand Police" bd. (Pits street 12, Riga, Latvia, VAT reg. nr. LV40003378078) to charge the amount of EUR from the below mentioned credit card for all requested services.* Type of Credit Cant Credit Card Number: Cryptogram number (CVC): Expiry date: Holder's Name: *Request cannot be processed without a legible front and back side copy of the credit card. Holder's signature: Date: Company stamp: (if applicable) THE LEADING HOTELS OF THE WORLD' EFTA00301019