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Tampa Bay Extended Stay Hotel Clearwater/Largo

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Tampa Bay Extended Stay Hotel Clearwater/Largo

6500 Ulmerton Rd <> Largo, FL, 33771 <> Tele: 727-532-4800 <> Fax: 727-507-8527 <> largofrontdesk@gmail.com

Credit Card Authorization Form


Card Holder Name:__________​PD​_​Schuler​__________________________________________

Card Holder Account Number:_____________________________________________

Credit Card Experation Date: ​ / ​ CVC Number:_______

Card Holder Billing Address:__​11233 Sol Vista Dr.

City:______​Largo​_______________________ State:_____FL____ Zip Code:__33774__

Card Holder Telephone Number:____​727-488-2122​____________________________________

Card Holder Fax Number:______________________________________________________

Arrival Date:__​10/3​________________________ Departure Date:_____​10/15​___________

Guest Name:______​Christopher Schuler​__________________________________________

________________________________________________________________

Charges that may be applied to the above card: Room & Tax Only______ All Charges__​X​___

Any reservation made for a guest of the Card Holder listed on this page must be cancelled 24 hours prior to the
arrival date to avoid a penalty of 1 night rate plus tax.

Cost of damages, repairs, replacements or excessive cleaning of the guest room, furnishings, fixtures and equipment
will be charged the above listed credit card should it be deemed necessary by hotel management.
By signing below, I, the credit card holder listed above, understand and agree to accept any charges billed to the
above mentioned credit card account based on the terms and conditions of this agreement and those established by the
card holders credit card company.

Card​ ​Holder Signature (as it appears on the card)___________________________________

Please completely fill out this document and E-Mail or Fax back to the Tampa Bay Extended Stay Hotel
Clearwater/Largo

Please include a copy of the front and back of credit card and a copy of the card holder’s driver’s license or state
identification.

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