requested below to ensure prompt processing. We ask that you either fax this completed form to The Peninsula Spa at (212) 903.3958 or e-mail it to Third Party Payment of Services ONLY Guest Name: gAT ri •4 "RUCE:frtit.--(Eg.. Date of Services: Rate Information and Approved Charges Services: ilvbaysyv..) a, 0,0 -14 Se."4.