Option 1: Please email the completed form to firstname.lastname@example.org along with a copy of your Driver’s license & credit card.
Option 2: Fill the form below - upload a copy of your Driver’s license/credit card and press send.
CREDIT CARD AUTHORIZATION FORM
Reservation Confirmation Number: Arrival Date : Room & Tax: I hereby authorize the following charges to be applied to the following credit card. Check all that apply: Credit Card Billing Address: City / State / Zip / Country: Please email this completed form to: email@example.com Credit Card Number: Expiration Date: CVV #: Amount to be charged: $ Cardholder Phone #: I hereby authorize Blue Water Motel to charge $ on my credit card listed above. Signature of Card Holder: