CREDIT CARD AUTHORIZATION FORM
Hotel- alHyatt Regency-
Individual/Business/Group or Event Nam*:
Reservation Confirmation Number: MI
Arrival or Event (Weis):
Credit Card Billing Address: 9 East 71st Street
City / Stater Zip 1Countryi Region New Yorke NY 10021, USA
:
Contact Phone Number:
Contact Email Address:
• A valid telephone number and email are required we
as will need to contact you to confum receipt. If we ore
unable to do so, your
reservation will be subject to cancellation.
I hereby authorize the following charges to
be applied to the following credit card. Check all
that apply:
j Room & All Applicable Taxes
C GIh Certificate El All Stay Charges
❑ Food & Beverage CI Only SpectfK Incidentals ❑ All Banquet Charges ❑ Guest Amenity
C All Incidentals D Resort Services Fee C Parking r:
Other see comments
hereby authorize the following amoun
t be applied to the
credit card (applicable sales tax and service
charges may apply): sac
•In Australia: An additional service fee will apply
to the total stay account when paying by AMEX, Diners and oil
upon departure (excluding Park Hyatt Sydney). Refer to other credit cords
the hoters webute for more details.
Comments:
• The credit card listed below may be billed for the
estimated charges Ten (701 days prior to iwenterservet
• Room and tax on individual bookings will be charged iondate.
72 hours in advance.
Credit Card Number.
Name on Card: Jeffrey Epstein
Expiration Date:
Cardholder Phone Is: I
Signature of Card Holder
kc anutagemgc/ ____ Current Date: 5/18(19
• Hotel reserves the right to refuse a credit
card od payment for same day bookings or authorization
received on day of arrival.
11 geeing
SySubmitting this form and any supposing. .
you In atccedance with row GSOtwl Pr
rs I tonfnm that. Nye read and agreed to rne v>e d the persona
'icy for Gaut whichisavailablea prnaKyhyatt corn
l Information I am
Please fax this completed form to:
Hotel Fax e: L
For a Nit of all hotels and thrir contact infra motion
. ;weave visit hrosilweise nyall.COrnihyatt1SitemaP
ISO
All information Is kept confidential end used only
for the purposes as noted above
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