Executive Stay CC Authorization Form

Executive Stay For You

Credit Card Authorization Form
I, authorize Executive Stay For You to charge the following:
- 3.75% Loft/Condo Room Tax
- 3.5% Convention & Sports Tax
Corporate Information
Name of Person Booking Executive Stay*

First NameLast Name
Company Name

First NameLast Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number
Please enter a valid phone number.
Payment Information
Name on Credit Card*

First NameLast Name
Credit Card Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Credit Card Number*
Credit Card Expiration Date*
CC Security Code*
Signature*

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Today's Date*

MonthDayYear
Date
Name of HR/Company Supervisor *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Upload Photo Id and Credit Card (front & back of both) *

Cancelof
Authorization must be received 24 hours before the date of arrival.

Once you book and pay for a 1, 2, or 3-night stay, cancellations are not allowed. However, you may reschedule your stay for a later date, subject to availability.

Executive Stay for You
5316 Pershing Ave.
St. Louis, MO 63112

Office: 586-232-3027
Fax: 586-232-3098

Please list all authorized guest(s):*

	Date of Arrival Number of Nights	Confirmation #
1
2
3
4

Executive Stay For You