PULLMAN RIM OLD TOWN HOTEL
24 JEKABA STR. LV-1050
RIM LATVIA
+371 67815444
AUTHORISATION TO CHARGE
MY CREDIT CARD ACCOUNT
Room reservation conformation Nr.... ... ...
Name (as it appears on card):
Card type (please check): VISA
Mastercard / Eurocard
Maestro
Card number:
Expiry date:
By signing this form, I authorize Hotel Pullman Riga Old Town to charge my
credit card account with the following amount:
(currency)
(amount) for
(description of the services purchased; confirmation/invoice number):
Date:
Place of signing:
Signature of cardholder:
Completed authori
1371 67815444
Contact person handling my bookings:
Please keep a copy of this form for your own records!
EFTA00293605