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ATTN: _______________________
HILTON FAMILY CREDIT CARD AUTHORIZATION FORM
Do not send completed form by email.
FAX COMPLETED FORM TO: _______________________
CARDHOLDER - Please complete the following section and sign/date below.
Guest / Group Name:
Confirmation Number:
Check-In / Event Date:
Name of Person/Group Making Reservation: Phone:
Cardholder Name as it Appears on Credit Card:
Cardholder Billing Address:
City: State: Zip:
Daytime /Business Telephone: Evening Telephone:
Credit Card Number: Expiration Date:
Credit Card Type: (Check One)
☐ Visa/MasterCard ☐ American Express ☐ Discover ☐ JCB ☐ Diners Club
Credit Card Issuing Bank Name: Bank Phone Number (from back of your credit card):
I agree to cover the following categories of charges: (Please Check)
☐ All Charges ☐ Room & Tax ☐ Food & Beverage ☐ Retail
☐ Recreation
I agree to cover the above categories of charges up to a Maximum Amount of $ __________________
DIRECT BILL ACCOUNT PAYMENTS ONLY: (For direct billing customers paying by credit card)
Name on Invoice/Statement _______ ______ Date on Invoice/Statement ______________
Invoice/Statement Number ________________________________________ Authorized Amount $_______________________
Note: Cha
rges for room and tax, group deposits or direct bill account payments will be charged to your credit card
immediately. Any incidental charges circled above will be charged at the time of check-out.
Amount to be im
mediately charged to credit card for room and taxes or deposit: $______________
Final Balanc
e Billed to Credit Card (hotel use only): $_______________
By signing below, you authorize the hotel to charge your credit card immediately for the amount indicated above up to the “Maximum
Amount” indicated above. You further acknowledge that if “all charges” has been selected, then all guest/group related charges (less
Deposit) will be charged to the above card number at the time of check-out or event conclusion.
Cardholder Signature: Date:
HOTEL USE ONLY
Authorized Amount: Approval Code: Date:
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