Epworth By The Sea • St. Simons Island, Georgia
June 2 - 7, 2019
MEALS OPTION ONLY
Address Line 2
Please enter all meals you plan on eating at Epworth By The Sea,
then enter the total based on the following rates:
Breakfast - $9.27 + tax = $9.92
Lunch - $12.88 + tax = $13.79
Supper - $14.94 + tax = $15.99
SELECT ALL THAT APPLY:
Total for Meals:
PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATION.
Checks payable to Epworth By The Sea
Or Submit Credit Card Information Below:
Name on Card
Amount To Charge:
Credit Card Number
Expiration Date (mm/yy)
3 Digit Security Code:
Billing Address Zip Code:
I am authorized to make these credit card charges:
2019 Cancellation Policy:
Full refund on or before May 15, 2019
Any cancellations made after May 28, 2019, will forfeit entire rate.
Any date changes made to reservations after May 28, 2019 will not be refunded.
RESERVATIONS NOT ACCEPTED BY PHONE
BUT MAY BE MAILED, FAXED, OR EMAILED TO THE INFORMATION BELOW
Please submit this form online, or you may print & FAX to 912-634-0642, or mail to:
Epworth By The Sea
P. O. Box 20407
St. Simons Island, GA 31522
Please email any questions to: email@example.com
* CONFIRMATION OF YOUR RESERVATION WILL BE MAILED OR EMAILED TO YOU *
No phone reservations accepted. No pets or alcohol.
This form is for Epworth By The Sea ONLY.
* PURCHASE ORDER CREDIT CARD AUTHORIZATION FORM*
*Credit Cards must be issued by the State of Georgia. State issued credit cards are tax exempt. Sales tax and hotel/motel tax exemption forms must accompany this form. Associations, booster clubs and personal methods of payments are not tax exempt.
CREDIT CARDHOLDER INFORMATION:
NAME ON CREDIT CARD:
TYPE OF CREDIT CARD:
AUTHORIZED USER OF CREDIT CARD:
RELATION TO OWNER:
TYPE OF CHARGES:
DATES OF CHARGES:
AUTHORIZATION OF CARD USE:
I certify that I am the authorized holder and signer of the credit card referenced above.
I certify that all information above is complete and accurate.
I hereby authorize collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the "AUTHORIZED AMOUNT" field. I understand this is only for up to this amount during the time period of "DATES OF CHARGES" referenced above. If additional charges are going to be authorized a new form will have to be completed.