Super 8 Motel of New Paltz
7 Terwilliger Lane
New Paltz, NY 12561
Phone: (845) 255-8865
Fax: (845) 255-1629
The New Paltz Super 8 Motel hereby approves the removal of the following pre-authorization(s) (often made for $100 per room held) from our establishment on the following credit card:
Credit Card Information and Holder:
(to be filled out by the actual credit card holder)
1. Name
of Credit Card Holder:____________________________________
2. Home Phone # of Card Holder:__________________________________
3. Work Phone # of Card Holder:__________________________________
4. Home Address of Card Holder:__________________________________
5. Date(s) of Pre-Authorization:____________________________________
6. Credit Card Number:__________________________________________
7. Credit Card Expiration:________________________________________
8. Signature of Card Holder:______________________________________
9. Date Form was Completed:_____________________________________
10. Fax Number to Send Completed Form:____________________________
Super
8 Motel of New Paltz Information:
(to be filled out by current front desk clerk)
1. Name of Front Desk Clerk: _____________________________________
2.
Merchant Id #:_______________________________________________
3. Signature of Clerk:____________________________________________