Tazewell Motor Lodge 
Fax/Credit Card Authorization Form
Fax Number: 423-626-2600


Name: __________________________________

Address: _______________________________

City, State, Zip: ____________________________

Phone: _______________________________________

Email: _______________________________________

Company Name: ________________________________

Date of Arrival: _____________________________

Number of Nights: ____________________________

Number of Guests: ____________________________

Accomodations Required: ______________________
Crib: ____   Cot: ____


Credit Card Information
Name (as it appears on card): ____________________________

Credit Card Number: ______________________________________

Expiration Date: _________________________________________

Billing Address for Credit Card: 

_________________________________________

_________________________________________


Signature: ___________________________  Date: ____________


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