Credit Card Authorization Form AL Serial #

Mahoning Inn www.mahoninginn.com
71 Blakeslee Blved. East, Lehighton, PA 18235
Ph: 610-377-1600 Fax: 610-379-0194

Note: Please print this form. Fill out and fax back before guest check in.
There is a 3% processing fee. (IE $50*3%=$1.50)

I, Mr./Mrs.__________________Authorize Mahoning Inn to charge my credit card
for _____nights plus tax for a total of $________.

I allow the following charges to be charged on my credit card.

Phone Charges:Yes/No DVD Charges:Yes/No Incidental Charges:Yes/No

Arrival Date:________ Departure Date:_________
Card Type:__________ Security Code(3 digit on back)______
Card #:___________________________________________ Expiration Date:_________
Card Holder's Name:____________________ Company Name:____________________
(Capital Letters)

Contact Number: 1.________________________Email___________________________
2.________________________
I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED ON THIS ACCOUNT.
Card Holder's Signature:________________________________Date:__________
Card Holder's Address:_______________________________________________
________________________________________________
________________________________________________
BECAUSE OF SECURITY REASONS WE ASK YOU TO PLEASE ATTACH
A COPY OF YOUR DRIVES ID AND CREDIT CARD FRONT AND BACK
*One authorization letter can be used for one stay unless you want to set up "OPEN AL"
You can discuss this option with a manager.
We appreciate your business. Thank You
Mahoning Inn

All Major Credit Cards Accepted including

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