EFTA00313937.pdf

GRAND PALACE HOTEL RIGA - LATVIA Pik 4lItet 12 • Riga • IN 1050 • Latvia www.grandpalaceriga.com CREDIT CARD AUTHORISATION FORM Reservation for: Reservation from: APRIL, 3 , .30IT? Reservation until: APR kt- L ,cLO1V Resen'ation Nt. lal7 -5 -5Thpaa* I authorise Word Grad Palau" Lid (Pits street 12, Rip, Lawn, VAT reg. rat LV40003378078) to charge the amount of 5'&Or Do EUR from the below mentioned credit card for all requested services.* Type ofCredit Cut A taG-_)1- Credit Card Number. H Cryptogram number (CVC): Eva*. date: clay Holder's Name: Je-f-Tict2C-:`1 G. 1-riPS-reirJ 'Request cannot be processed without a legible (root and Holder's signature: Date: Aact-k a-oie Company stamp: (if applicable) THE LEADING HOTELS OP THI WORLD* EFTA00313937