GRAND PALACE HOTEL Reservation for: Reservation from: Reservation until: Resen'ation Nt. RIGA - LATVIA Pik 4lItet 12 • Riga • IN 1050 • Latvia www.grandpalaceriga.com CREDIT CARD AUTHORISATION FORM APRIL, 3 , .30IT? APR kt- L ,cLO1V lal7 -5 -5Thpaa* I authorise Word Grad Palau" Lid (Pits street 12, Rip, Lawn, VAT reg. rat LV40003378078) to charge the amount of 5'&Or Do EUR from the below mentioned credit card for all requested services.* Type of Credit Cut Credit Card Number. Cryptogram number (CVC): Eva*. date: Holder's Name: A taG-_)1- H clay Je-f-Tict2C-:`1 G. 1-riPS-reirJ 'Request cannot be processed without a legible (root and Holder's signature: Date: Aact-k a-oie Company stamp: (if applicable) THE LEADING HOTELS OP THI WORLD* EFTA00313937