PULLMAN RIGA OW TOWN HOTEL
24 JEKARA STR. LV-1050
RIGA LATVIA
+371 67815444
H9619@accor.com
PULLMANNOTELS.COM ACCORHOTELS.COM
AUTHORISATION TO CHARGE
MY CREDIT CARD ACCOUNT
Room reservation conformation Nr.
Name (as It appears on card):
Card type (please check):
VISA
n Mastercard / Eurocard
Maestro
111
Card number:
Expiry date: aolP
By signing this form, I authorize Hote
l Pullman Riga Old Town to charge my
credit card account with the following
amount:
(currency) LA Lt....A eiS
(amount) t liOO. 4" for
(description of the services purchased; confirmation/invoice number):
IQD Dik-4
Date: NOV II Q01 -4--
Place of signing:
Signature of cardholder:
Completed authorization form should be
:d to: H9619@accor.com
+371 67815444
Contact erson handl' okings: t -E-7- --?•4-±-
AME,c Ce4-nAR.rvt-i
Please keep a copy of this form for your
own records!
EFTA00313771