Credit Card Billing Authorisation

A temporary charge of $1.00 will be applied to the credit card. This will be refunded once billing information is confirmed.

Name of Guest*
First Last
ACN/ABN
Company/Department Name
Service Required*
- Accommodation only
- Accommodation and catering
Service of Alcohol*
- Alcohol allowed
- No alcohol allowed
Check-in Date*
Date Format: DD slash MM slash YYYY
For how many days?*
Billing Information
Credit Card*

American Express
Discover
MasterCard
Visa
JCB
Maestro
Card Number Expiration Date Security Code Cardholder Name
Amount
Authorisation Transaction
Address*
Street Address City State Postcode Country
Billing Authorisation
Name*
First Last
Position Title
Email*
Consent*
I authorise Carnarvon Motel to take payment for accommodation on the credit card supplied.*
Consent*
I authorise Carnarvon Motel to take payment for accommodation and catering on the credit card supplied.*
Consent*
I agree to Carnarvon Motel's Terms & Conditions.*
Signature*

Billing Information