Hotel Elysee

- Gift Certificate Credit Card Authorization Form -

Today’s Date

I, , authorize the Hotel Elysee to charge my credit card for the following amount, plus $5 shipping and handling, towards the purchase of a gift certificate which will be valid for up to one year from the date of issue.

A gift to:		Name of Recipient
From:		Your Name (as you want it on the certificate)

Please Select the Amount $250 $500 $750 Custom Amount:

Request Rush Delivery for an Additional $15 in the Continental US only (Total S&H=$20)

At the Hotel Elysee all room rates include the following:

Bountiful European style breakfast buffet
Selection of coffee, tea, juices, cookies, and fruits throughout the day
Wine & Hors d'oeuvres reception Monday- Friday evenings from 5-8pm
Complimentary wireless high speed Internet access
Evening turndown service
Complimentary passes to nearby New York Sports Club

Billing Information

Credit Card Type:
Credit Card Number:
Credit Card Expiration:	Month: Year:
Name on Credit Card:
Card Holder's Signature:
Billing Address:
Phone Number:
Email:

Please complete the Gift Recipient fields below only if you’d prefer the gift certificate and brochure to be delivered directly to the recipient. Otherwise, the gift certificate and brochure will be delivered to the billing address above.

Gift Recipient (optional)

Recipient’s Name:
Recipient’s Full Address:
Message:		(i.e. Happy 50th Birthday!)

Please fill out and print, then, for your security, please sign and send to us by mail or by fax:

ATTN: Kimberly Watson
HotelElysee
60 East 54th Street
New York City, NY 10022
FAX: 212-838-2468

Hotel Elysee

- Gift Certificate Credit Card Authorization Form -

www.elyseehotel.com