riRENZE CREDIT CARD AUTHORIZATION FORM
Credit Card Type A M Credit Card NumberMEM Expiry Date le/ c) I
Name of Cardholder TErYK PSTE~r.I
Address where statement of account is mailed:
Street 7 E4ST 3-)sr City Mew ca.e._
State Country (ASA
I authorize Relais Piazza Signoria to charge for my reserv
ation the above credit card number for the
amount of Euro -3a C.-,c C 6LARQ..5
Check-in..N0V%% - Check-out.. 14 Q.V. 3, atie
Total nights are .3.. Total amount is turn
This reservation cannot be canceled.
Cardholder signatur
Raids Pima *nods Vacchereals, 3 50122 Wylie Tel..39 055 3987239 Fax .39 055 2863C6
EFTA00314079