ASSUMPTION OF LIABILITY

This form serves as an official authorization to charge my account for the specified bill incurred at SEQUOIA HOTEL, QUEZON CITY.

COMPANY NAME EVENT DATE EVENT NAME

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ASSUMED CHARGES All Charges

Please check & note applicable charges Room Only Banquet Charges

Incidental Charges (Please Specify):

Guarantor Information

NAME OF CARDHOLDER CREDIT CARD NUMBER EXPIRY DATE/ CVV/DBC MAILING ADDRESS TELEPHONE/ EMAIL CARDHOLDERS SIGNATURE

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