StarCity

Credit Card Authorization Form

Please complete all fields. You may cancel authorization at any time by contacting us.

Star City Inn & Suites

1308 N Lincoln Ave, Star City, AR 71667

Phone: (870) 628-6883 | Fax: (870) 628-6889

Email: scinnsuites@gmail.com

I, (please print) , authorize Star City Inn & Suites to charge the credit card provided below as payment for one of the following:
(Please check the item(s) you agree to pay)

A) Room, Tax, and In-Room Safe Charges ONLY (Guest pays ALL other charges) B) Room, Tax, In-Room Safe, Phone and Fax Charges (Guest pays ALL other charges) C) ALL Charges (Includes all charges associated with stay) D) Amount ($) (Guest pays any remaining balance)

Name on Credit Card

Company Name (if applicable)

Type of Card

Expiration Date

Credit Card Number

Security Code (CVV)

Billing Address

Guest Name(s)

First Name

Last Name

Arrival Date

Departure Date

Adults

Kids

Contact Phone

Cardholder Signature

Date

Copy of Driver License

Front of Credit Card

Back of Credit Card

Required Documents: Copy of Driver License and Credit Card (Front & Back).