Credit Card Charge Authority

WA STATE SCHOOL REGISTRARS (WASSRA 2016) 22th – 28th August 2016 Accommodation Booking Form A block of rooms has been reserved at Crown Metropol Perth for WASSRA 2016 and will be held until Friday 22nd July 2016, after this date all reservation requests will be subject to Hotel availability. Hotel check-in is from 3.00 pm and check-out is 11.00 am

Signature: ______Date:______Please return completed form & copy of Credit Card Authorisation or Purchase Order to:

Attention: Mrs. Alia Ariff - Group Reservations Department Phone: 08 9362 8008 Email: [email protected]

Please note bookings are limited, all room requests will be subject to availability and early booking is recommended. Telephone reservations and/or amendments will not be accepted

CREDIT CARD CHARGE AUTHORITY

Guest Name:______

Group BookingName: ______

Arrival Date: ______Departure Date: ______

Confirmation Number:______

Room Type: ______

Room Rate Per Night: ______

Inclusions: ______

Accepting (PLEASE TICK): □ Room Only Charges □ Room and Breakfast Charges □ Package Cost Only □ All Charges Incurred □Other Charges (Please Specify) ______

I, the undersigned, hereby authorize Crown Promenade Perth and/or Crown Metropol Perth to debit my credit card as detailed below:

*Please note, a service fee of 1.65% applies to account settled by credit card. Alternatively, payments can be made up to ten business days prior to arrival via cheque or bank deposit. Please enquire for further information. □ MasterCard □ Visa □ Amex □ Diners □ JCB

Credit Card Number: ______CVV: ______Expiry______

Total Cost Including GST*:______

Cardholders Name: ______

Mailing Address: ______Email Address: ______

Contact Phone: ______

Cardholder Signature: ______

Cash/EFTPOS Deposit Policy Please note that a security deposit is required upon check in, as well as photo identification. The deposit will be to the value of the total accommodation (if not pre-paid in advance) plus an additional $200 per night. After settlement of the bill, any remaining funds will be returned to the guest providing there is no outstanding amount owed.

Credit Card Policy Please note that a pre-authorisation is required upon check in. This pre-authorisation will be to the value of the total accommodation (if not pre-paid in advance) plus an additional $100 per night. After settlement of the bill, any remaining funds will be released depending on the credit card and individual bank policy.

On completion of this form, please return to Group Reservations via email: [email protected]