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IHRCO CC_authorization form

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IHRCO CC_authorization form Powered By Docstoc
					                                     201 N. 17th Street
                                  Philadelphia, PA 19103
                      Telephone: (215) 448-2000 Fax: (215) 448-2853

                      CREDIT CARD PAYMENT
                      AUTHORIZATION FORM

NAME:       __________________________________________________________

COMPANY:    __________________________________________________________

ADDRESS:    __________________________________________________________

            __________________________________________________________

PHONE:      _______________________        FAX: __________________________

DATE OF EVENT: _____________________________________________


TYPE OF CREDIT CARD:
_______ AMERICAN EXPRESS                      ______ VISA/MASTERCARD
_______ DINERS                                ______ DISCOVER

CREDIT CARD NUMBER: __________________________________________
EXPIRATION DATE:    ________________

NAME OF CARD HOLDER:       ________________________________________

SIGNATURE OF CARD HOLDER: ________________________________________

THIS CARD IS TO PAY FOR THE FOLLOWING CHARGES:
______ BANQUET CHARGES                       ______GUEST ROOM & TAX
______ FOOD & BEVERAGE                       _______INCIDENTALS
______ ALL CHARGES



     Fax To: (215) 448-2853

				
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posted:9/28/2011
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