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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
(85, rue
de la Verrerie 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
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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