SLS LAS VEGAS Authorization to charge Credit Card (2 PAGES – PLEASE COMPLETE BOTH PAGES) PAGE 1 PLEASE PRINT ALL INFORMATION CLEARLY PURPOSE FOR CHARGE GROUP NAME (IF APPLICABLE): _______________________________________________________ GUEST FIRST NAME: ____________________________________________________ LAST NAME: ___________________________________________________________ TELEPHONE NUMBER: ___________________________________________________ FAX NUMBER: _________________________________________________________ CHARGE IS FOR (TICKETS / EVENT / ROOM / PARTY / DINING / TABLE SERVICE / CLUB / INCIDENTALS): ______________________________________________ WHICH OUTLET (ROOM / RESTAURANT / CLUB):_________________________________ DATE OF EVENT: _____________________________ CARDHOLDER INFORMATION PLEASE PRINT NEATLY THE INFORMATION BELOW AS IT APPEARS ON THE FACE OF THE CREDIT CARD: CARDHOLDER FIRST NAME: ____________________________________________ CARDHOLDER LAST NAME: _____________________________________________ CARD ISSUING BANK OR CORPORATE LOGO IF ANY: __________________________________________ CREDIT CARD CONFIDENTIAL INFORMATION CREDIT CARD NUMBER: (NOTE FIRST NUMBER STARTS WITH 3 IS AMEX, 4 IS VISA, 5 IS MASTER CARD) EXPIRATION MONTH AND YEAR: / SECURITY CODE (AMEX – FOUR NUMBERS PRINTED ON FRONT OF CARD – OTHERS – LAST THREE NUMBERS ON BACKSIDE OF CARD) CARD BILLING ADDRESS STREET: __________________________________________________________________________ CARD BILLING ADDRESS CITY: ____________________________________________________________________________ CARD BILLING ADDRESS STATE: _____________________________________ ZIP CODE: ___________________________ THIS PAGE TO BE DESTROYED WITHIN 3-DAYS AFTER THE ACTIVITY YOUR CREDIT CARD WILL BE CHARGED IMMEDIATELY AMOUNT YOU AUTHORIZE TO BE CHARGED TO THIS CARD: $______________________
Transcript
SLS LAS VEGAS Authorization to charge Credit Card
(2 PAGES – PLEASE COMPLETE BOTH PAGES) PAGE 1
PP LL EE AA SS EE PP RR II NN TT AA LL LL II NN FF OO RR MM AA TT II OO NN CC LL EE AA RR LL YY
PURPOSE FOR CHARGE
GROUP NAME (IF APPLICABLE): _______________________________________________________ GUEST FIRST NAME: ____________________________________________________ LAST NAME: ___________________________________________________________ TELEPHONE NUMBER: ___________________________________________________ FAX NUMBER: _________________________________________________________ CHARGE IS FOR (TICKETS / EVENT / ROOM / PARTY / DINING / TABLE SERVICE / CLUB / INCIDENTALS): ______________________________________________ WHICH OUTLET (ROOM / RESTAURANT / CLUB):_________________________________ DATE OF EVENT: _____________________________
CARDHOLDER INFORMATION
PLEASE PRINT NEATLY THE INFORMATION BELOW AS IT APPEARS ON THE FACE OF THE CREDIT CARD: CARDHOLDER FIRST NAME: ____________________________________________ CARDHOLDER LAST NAME: _____________________________________________ CARD ISSUING BANK OR CORPORATE LOGO IF ANY: __________________________________________
CREDIT CARD CONFIDENTIAL INFORMATION
CREDIT CARD NUMBER: (NOTE FIRST NUMBER STARTS WITH 3 IS AMEX, 4 IS VISA, 5 IS MASTER CARD)
EXPIRATION MONTH AND YEAR:
/
SECURITY CODE (AMEX – FOUR NUMBERS PRINTED ON FRONT OF CARD – OTHERS – LAST THREE NUMBERS ON BACKSIDE OF CARD)
THIS PAGE TO BE DESTROYED WITHIN 3-DAYS AFTER THE ACTIVITY
YOUR CREDIT CARD WILL BE CHARGED IMMEDIATELY
AMOUNT YOU AUTHORIZE TO BE CHARGED TO THIS CARD:
$______________________
SLS LAS VEGAS Authorization to charge Credit Card
(2 PAGES – PLEASE COMPLETE BOTH PAGES) PAGE 2
AUTHORIZATION TO CHARGE CREDIT CARD (BY AUTHORIZED SIGNER)
PLEASE PRINT NEATLY THE INFORMATION AND COMPLETE ALL INFORMATION BELOW: CARDHOLDER FIRST NAME: ____________________________________________ CARDHOLDER LAST NAME: _____________________________________________ CARDHOLDER TELEPHONE NUMBER: _____________________________________ CARDHOLDER ID NUMBER: _____________________________________________ TYPE OF ID (ISSUING STATE / PASSPORT / LICENSE): _______________________
LAST FOUR NUMBERS OF CREDIT CARD: ______________________ TYPE OF CREDIT CARD: (AMEX/VISA/MASTERCARD): ___________________________________________________ AMOUNT YOU AUTHORIZE TO BE CHARGED: $______________________________________ AGREEMENT FOR CHARGE I, THE ABOVE NAMED CARD HOLDER, AUTHORIZE THE LOCATION TO CHARGE MY CREDIT CARD (ACCOUNT NUMBER NOTED ABOVE). I AGREE TO PAY THE CHARGED TOTAL AMOUNT ACCORDING TO THE CARD ISSUER AGREEMENT. I STIPULATE THAT CHARGES MADE FOR THIS EVENT ARE NON-REFUNDABLE AND NON-TRANSFERABLE. I UNDERSTAND MY CREDIT CARD WILL BE CHARGED IN FULL UPON RECEIPT OF THIS FORM. I WARRANT THAT I AM AWARE THAT FOR ROOMS, ACCOMMODATIONS ARE SUBJECT TO CHANGE AND AVAILABILITY. FOR RESTAURANTS, ITEMS AND TABLES ARE SUBJECT TO CHANGE AND AVAILABILITY. FOR CLUB SERVICE, NOT ALL GUESTS CAN BE GUARANTEED A SEAT NOR CAN ENTRANCE OF ENTIRE GUEST PARTY BE GUARANTEED AS CONDUCT, OCCUPANCY AND OTHER FACTORS MAY PREVAIL. I UNDERSTAND THESE CONDITIONS AND ACCEPT THEM KNOWINGLY AND RELEASE VENUE FROM ANY LIABILITY OR CHARGE OF NON-PERFORMANCE BASED ON THESE CONDITIONS. IN ORDER TO RECEIVE REFUND, CANCELLATION POLICY OF THE VENUE MUST BE ADHERED TO (A MINIMUM OF 62 HOURS PRIOR TO VISIT/NO REFUND FOR SPECIAL EVENTS AND HOLIDAY EVENT PURCHASES). I HEREBY AGREE TO ALL THESE TERMS AND CONDITIONS AND AUTHORIZE THE VENUE TO CHARGE MY CARD AS REQUESTED IMMEDIATELY. FURTHER, I AUTHORIZE THE VENUE TO PERFORM IDENTITY VERIFICATION WITH MY ISSUING CARD COMPANY.
1) The difference between the Stay for Play Minimum Room Night Requirement of 30 rooms (10 Rooms with a 3 night minimum) and the Teams final room nights paid at the Team Hotel at the Rate/Night (pre tax/applicable resort fee).
2) 1st Nights stay or full reservation amount at the Team Hotel (determined by hotels cancellation policy through the Tournaments contract with the Hotel) at the Rate/Night (pre tax/applicable resort fee) for any cancellations or no shows outside of the Tournament Cancellation timeframe.
Cardholder Name (please print):
Cardholder Billing Address:
City: State: Zip Code:
Phone Number: Email:
Type of Card: □ VISA □ MASTERCARD □ AMERICAN EXPRESS □ DISCOVER
Card Number: Exp. Date (mm/yy): Security Code*:
*The non – embossed 3 digits printed on the signature panel on the back of your card immediately following the cardnumber. The American Express security code is the non – embossed 4 digits printed on the front of the card.
Notify cardholder of the full amount to be charged the card listed above prior to processing payment
Yes (Select Method) Email Phone Decline Notification By checking the box, I acknowledge that I am the responsible party for the Soccer Team /Club listed above and for the
teams Tournament hotel reservations. I will also inform the team and players of the process and deadlines for any changes, no shows or cancellations at the Teams Hotel. Changes and Cancellations MUST be submitted in writing to [email protected] on or before Friday, October 21, 2016 to avoid any penalties or non –participation in the Tournament.
By checking the box, I authorize Las Vegas Thanksgiving Classic (c/o Eventure, LLC, DBA Sports Tournament Concierge) to charge the credit or debit card provided on this credit card authorization form the amount authorized above.
Cardholder Signature: Date:
E-Mail form to [email protected] or call (702) 202-2107 with any questions.
