Hotel Registration

Name *

E-Mail *

Phone Number *

Payment Plan Monthly Payment PlanQuarterly Payment PlanNo Payment Plan / Lump Sum PaymentUndetermined

This payment is a ... DepositDeposit – Partial or pre-salePayment – Per payment planPayment – Final / Last paymentPayment – Full lump sum / no payment planNo Payment – Change of credit cardOther (please specify in the comments box below)

Billing Street Address

Billing City & State

Billing Zip Code

Card Number You Authorize

Expiration Date (MM / YY) *

Amount to Charge

Security / Verification Code

Electronic Signature * YES : Credit Card / Debit Card Authorization is ApprovedNO : Credit Card / Debit Card Authorization is Not Approved

Comments & Questions