CC AUTH -

Cambria Madison East Credit Card Preauthorization Form

Please complete all of the required fields below and submit to be processed. If you are unable to complete this form online, please print out the PDF form, fill it out and fax it to 608-241-9090 or email it to FD@madison-cambria.com.

I, (name) authorize Cambria Madison East to process my credit card for the noted items below.

This field is required.

Choose all that apply:

Room, tax only

Room, Tax, Incidentals (Restaurant, Lounge, Movies)

Keep on file for future charges

Banquet / Meeting room charges

Group advance deposit

Shipping / Postage

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Company name, group or guest name:

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Arrival date or NA

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Departure date or NA

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Cardholder Name

Enter the name as it appears on the credit card.

This field is required.

Billing Address

Enter the billing address associated with the credit card.

This field is required.

Credit Card Number

Enter your 16-digit credit card number without spaces or dashes.

This field is required.

CVV

Enter your 3-digit CVV code

This field is required.

Expiration Date

MM/YYYY

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Email Address

Enter your email address to receive confirmation.

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Phone Number

Enter a contact phone number for any questions regarding your authorization.

This field is required.