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INVOICE / CREDIT CARD AUTHORIZATION
AGREEMENT
Please
fill out, sign and fax to Roots Travel at +331- 42 74 01 01. After
we process your payment we will send you a receipt.
Name: _____________________________________ E-mail: ______________________________
Tel: _______________________________________ Fax: ________________________________
Independent apartment Reference (type and address of apt.): _________________________________
________________________________________ Period: ________________________________
Number of persons: __________________________ Number of days: ________________________
Arrival time in Paris: ___________________________ Departure time*:
________________________
* to arrange an appointment with our agent at the apartment for inspection
before your departure.
Total including all utilities in euro: _____________________________ euro
Security deposit (not debited from your card, see "conditions"):
________________ euro
Additional services:
- Taxi service: Taxi with chauffeur and keys of your rental apartment:
YES
NO
Airport-Apartment One Way: 70 euro 
YES
Round Trip: 140 euro
YES
Rail Station-Apartment One Way: 44 euro
YES Round Trip: 88 euro
YES
Keys will be picked up at the office of the agency during opening
hours:
YES
(7 rue de
la Cerisaie, 75004 Paris, from Mon. to Sat. 10am-1pm and 2-7 pm, Mon.
closes at 6pm, Sat. opens at 11am)
- Extra cleaning
service, 2 hours: 40 euro
YES
NO
This is to certify that I, __________________________________________________________,
hereby authorize ROOTS TRAVEL to debit my Visa / Master Card
Credit Card Number: _________________________________________________________________
Card Identification Number (The last 3 digits of the number printed on
the back of the card): _________
Expiring on ______________________________ for the amount of ________________________
euro
Card billing address _________________________________________________________________
as payment of rent at ________________________________________________________________.
In addition, I authorize ROOTS TRAVEL to debit my credit card for
the remaining balance to be paid
in full one month before arrival ______________________ euro
In the event that
we cannot process the remaining balance of your reservation one month
before arrival we will contact you by email. If we have no response from
you to make arrangements for the payment of the balance, the agency reserves
the right to cancel your reservation at the conditions of the cancellation
fee.
I represent that
the premises will be occupied only by myself and my _______________ guest(s)
arriving on _________________________ and departing on ________________________.
I agree that my credit card may also be used as a guarantee against any
additional charges (see
"conditions"/ "security deposit")
that I, or my guests, may incur as a result of our occupancy of the above
captioned premises including, missing or damaged property (beyond normal
wear and tear).
"Conditions"
read and approved.
Signature ___________________________________ Date______________________
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