Debit bases

TO: Nordic Sea Hotel
Att: Reservations
Fax: +46 8 50 56 31 16
date:

Debit bases        

Name:  

Booking ref:    

Arrival:                                    

Departure:          

Room type:       

Total amount SEK:                          

Hereby, I approve that Nordic Hotels in Stockholm AB charges the above amount on my credit card and encloses also a photocopy of my credit card´s front- and back

Card type:  

Card numbers:  

Expire date:

Debit date:

Name:

Address:

Zip code, Town &  Country:

Signature: