SOCCO FORTE HOTELS CREDIT CARD AUTHORISATION FORM Cornaweime o6 °malt Please complete and fax the form to noacagyitera, aanomurre gmmyto dtopsty H oilman hTe cc no 4aKcy Or alternatively email to the following dedicated email address : HRH am sore tta 3Ae HH 10 110 I will be responsible for charges to the value of / ft paspeuiato oune c smellxamw crony a paamepe : SU@OO Pt,- et 3a m OH 3 i " Single event /Exmoor:oedema EI Monthly /Exemecammo Annually /EmeroApo K Other/APyroe K Please specify/Elowanykra, noacHme I wish the charges incurred on the above account(s) to be settled in the following manner: paspemaso npomasecric cantle aemeammx cpeacrs r-nearouutm o6pasom: Credit Card Type: Tim XpeAliTH011 Kama A meta, e450-4. GRize.,-.3..S Cr edit Card Number. Homep KpeASITHOA Kapixi: First Four Dies nepliltae klertspe unthpbi s fil d + Last Four Digits flocneAmste clerave O1O µM$1) Credit Card Expiry Date: KapTa pteicTeetrenbna pp* O(4, / ca D I Issue Number (for Maestro only): Homep etanyao: (Tonno Me KapT Maestro) Start date (for Maestro only): NaPTa AerOCTB11TefibK3 C: (TO/W(0AM MOOT Maestro) /". Card Holder Signature: 004I1HCb pepxurcena KapTa: Name (In capitals): OHO (rleklaTHtaktIl 6reassui): Date/Rata: ECIEDEITIEHEOMMODO Statement Address for Credit Card / Aapec nddnoe"" Contact Telephone Number / Mom:rex-muff rene4om q ens-r t1 ST Si-pa>r NievO WRAC NN ice Proof of card holder's identification may be required with this form (Passport) / K Amami chopme moacer norpefacmarbca npuloacirm ammo aoaymeura, YAOCTOBepRIOUter0 JINtINOCII•Aepwarean (nacnopr) 0•40 I are aainwl • cd00•••••0 feaseitoli l AN-awao•••-• • ceasto• •••• strstrov after token isation . destroy after I tokenization. dateasftgritheafrartalegansftectQkenisadon Full Card Number/ Homep ita•xw: Credit Card Type / Ten 'cams,: EFTA00314069