Authorizing Person *

First Name

Last Name

Phone *

Country

(###)

###

####

Expiration Date *

MM

DD

YYYY

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please select one of the following payment options *

ONCE: Bill my credit card once for the current booking.

WEEKLY: Bill my credit card weekly for bookings.

MONTHLY: Bill my credit card monthly for (membership and lease solution customers)

Confirm and Authorize *

Applicant agrees that all information provided is accurate and complete. Applicant also acknowledges that all orders may be immediately terminated at company's discretion if any charges are declined or chargebacks are claimed against any outstanding invoiced amount. Disputes to amounts invoiced should immediately be reported to accounting@amitylodges.ltd. Any changes in status of this card can also be reported to accounting@amitylodges.ltd. I hereby certify that I am duly authorized and a representative on behalf of the above mentioned company and authorize AMITY LODGES to bill this credit card.

Confirm / Authorize