purchased lalso, state quantity): I assume responsibility for the above charges. Please sign Kindly fax to to the attention of Mandarin Oriental, New York Spa Please check off the following: For Office Use only: _ Copy for Guest Processed by: Date: u Copy for Spa o Copy for Finance (lW) EFTA0028634

Codes Item purchased [also, state quantity]: I assume respo ibility for a &TM. Please sign Kindly fax to (2 e attention of Mandarin Oriental. New York Spa Please check off the following: for Office Use only: o Copy for Guest Processed by: Date: o Copy for Spa n copy for Finance (1W) EFTA00313847