Cozy Crest Motel

7210 SEAVIEW AVE                                    PHONE 609 5220200

WILDWOOD CREST NJ08260                   FAX NO 609 8460646       

AUTHORIZATION OF PAYMENT BY CREDITCARD

CARDOWNER_________________________________________

CARD/BANK__________________________________________

NUMBER_____________________________________________

EXP.DATE________________

I Authorise to cozy crest motel to use my credit card for the payment of

room rent .

SIGNED ON:_________________ DATE_______________

OWNER'S SIGNATURE____________________________

(For Printable PDF Version of the Form, Click Here)