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
