Credit Card Authorization Form

Mermaid Inn Motel
727 El Camino Real
Menlo Park, CA 94025
(650) 323-9481 Office
(650) 323-0662 Fax
www.MermaidInnMotel.com

Please check box below:

Credit Card Number:

CVV# (       )

Card holders name:_________________________________

Billing Address: ____________________City____________

                           State:______ Zip Code:_______

By completion of form, you authorize Mermaid Inn Motel to charge

The above credit card for ____________________________________Guest Name?

School name:_________________________________________________________

Organization:_________________________________________________________

Please select: Queen, King, 2 double beds, Kitchenette

Phone: (         )       -  

Email: _______________________

Print name:_______________________________

Signature:________________________________

Date:___________

Paying for: Number of rooms:_____________ Number of Guest:__________

MUST INCLUDE COPY OF CREDIT CARD & CARD HOLDERS ID (MATCHING)