CREDIT CARD AUTHORIZATION AND PAYMENT CODE FORM

Date 

Roomorama Payment Code:

Your email address:

Your check in date:

Apartment name under reservation:

Name as it appears on credit card:

Credit card billing address:

I hereby authorize Splendid Management to charge my (please select credit card type)

Card Type:  

in the amount of $ in relation to the above referenced booking transaction.

Credit Card#:

 
Expiration Date:   /
Security Code: (last 3 digits on back of Visa or Mastercard)
 Your Initials:

Please email this form back to info@sirkinrealty.com

Thank you.

 403 East 62nd Street,New York,NY 10065 Tel: 212-838-3838