CREDIT CARD FORM Credit Card Form Credit Card Type*VISAMasterCardAMEXDiscoverName*As Shown on CardCredit Card Number*Expiration Month*010203040506070809101112Expiration Year*201920202021202220232024202520262027202820292030CVV*Phone Number*Billing Address*Arriving Guests Name(s)*Arrival Date* MM DD YYYY Departure Date* MM DD YYYY Daily Rate $Taxes 14.07%Total Rate $Incidentals $100*Use Existing Credit CardGuest will provide Credit CardConsent* I certify that all information is correct and accurate.I hereby authorize UNIVERSITY INN & SUITES to collect payment as indicated in the Rate Information above by processing a charge to the credit card listed above. I understand that a new form will need to be completed if guest wishes to extend his/her stay. I certify that I am the authorized signer of the credit card listed above. I understand that if the inn is unable to obtain approval on above mentioned card, that the inn will require an alternate form of payment and reservation will not be guaranteed. This iframe contains the logic required to handle Ajax powered Gravity Forms. Print Form