ccform | Quality Inn & Suites McAlester on Hwy 69

Authorized Guest Name

Confirmation Number

Arrival Date

Departure Date

Guest Email

Guest Phone

Charges authorized to be placed on card

All Charges

Room Charges

Incidental Charges

Other

Each selection will be inclusive of tax, service charges, and fees.

Total Amount (if known)

Note to Hotel

I hereby certify that all information provided is true and complete. I authorize the hotel to charge my account for the amounts indicated on this form, including any one-time or recurring charges as specified above. (Required)

Card Holder Phone number

Card Holder Email

Name on card (required)

Credit card number (required)

MM/YY (required)

CVC (Required)

Multi-line address

Country/Region

Address

City

Zip / Postal code

Signature

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By Submitting this form, you allow Quality Inn & Suites McAlester on Hwy 69 to save your payment information for charges ad indicated above on this form.