3rd Party Payment Authorisation Form

City Break Apartments
3rd Party Payment Authorisation Form

3rd Party Payment Authorisation

Personal Information

First Name *

Last Name *

Phone number *

Email Address *

Attach a photo of your Passport or National Identity Card *

Maximum upload size: 2.1MB

Attach a photo of the front of the card used for payment ( Only the last four digits need to be visible ) *

Maximum upload size: 2.1MB

First and second name of the person checking-in *

Phone of the person checking-in *

Add your booking Reference *

I certify by clicking this box that I authorise ( as the card holder ) the full payment for the reservation with ref above *

No Yes

I certify by clicking this box that the information submitted in this form is true and correct to the best of my knowledge. I further understand that any false statements may result in denial checking into the property
I understand also that by clicking this box I agree with City Break Apartments Terms and Conditions* *

No Yes

Signature *

Clear