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b, M <br />' <br />HampEonInn <br />Pendleton U <br />$ A <br />_ <br />101 SW Nye Avenue va Pendleton, OR 97801 official sponsor us olymplcteam <br />„4. <br />Phone (541) 276-3500 • Fax (541) 276-3510 <br />JACQUELYN name <br />"COREY <br />room number: 4231KXTO <br />, <br />30891SUMMIT TERRACE DR ~-address <br />arrival date: 10113/2010 5070OPM <br />- - <br />defearture,date: 1011512010 <br />EUGENE, OR 97405 <br />US <br />-adult/child: 110 = <br />room rate 7000• <br />If lire d.leVerodo card you are using for check in is attached to a bank at checking account, a hold will <br />- RATE PLAN C-APW - <br />ba placed an Ilia „ccount for ilia hill annnpatad dollar altwum in be owed to the hotel,dncWding <br />HH# 389566024 BLUE, <br />estimated incidentals, through your dale of check out and such funds will not be released her 72 <br />AL AS, #60187024' <br />hesmrss hems lunn the date of chock out or longer at the distribute d your Imanmal institution <br />BONUS AL CAR: <br />Rates subject to applicable sales, occup <br />other taxes Please do not leave any manoy or items at value unattended an <br />ancy, or <br />CONFIRM." TIO <br />N NUMBER 8 <br />7171751 <br />your mom A safe deposit box is availabl <br />, <br />e for you at the front desk I agree that my liability for this bill is not waned and agree <br />' to he held pe~sondly liable in the event <br />that the indicated person, company or association falls to pay for any part at the full <br />- amount of these charges In the event of <br />an emergency, I, or someone in my party, require special evacuation assistance due to a <br />10 1512010 <br />PAGE 1 <br />physical disability Pleese indicate yes by c <br />hecking here <br />signature:, - <br />M <br />10/13/201() <br />103280 <br />GUEST ROOM <br />$7000 <br />10113/2010 <br />103280 <br />STATE TAX <br />$070 <br />10/13/2010 <br />103280 <br />CITY OCCUPANCY TAX <br />$560 <br />10/13/2010 <br />103280 <br />TPA ASSESSMENT <br />$1 50 <br />10/14/2010 <br />103416 <br />GUEST ROOM <br />$7000 <br />1011412010 <br />103416 <br />STATE TAX <br />$0,70 <br />1011412010 <br />103416 <br />CITY OCCUPANCY TAX <br />$5.60 <br />10/142010 <br />103416 <br />TPA ASSESSMENT <br />$1 50 <br />WILL BE SETTLED TO MC *8582 <br />$15560 <br />EFFECTIVE BALANCE OF <br />$000 <br />EXPENSE REPORT SUMMARY <br />1 <br />0 00 00 007 12 00 OOAM STAY TOTAL <br />ROOM & TAX <br />$7780 $7780 $15560 <br />DAILY T <br />TAL <br />$7780 $7780 $15560 <br />TAX SUMMARY <br />CH <br />RGE TOTAL CITY OCCUPANCY TAX ST <br />TE TAX TPAASSESSMENT <br />ROOM & TAX <br />$140,00 $11 20 <br />13.00 <br />11 40 <br />pp <br /> <br />~ <br />0 <br />7 <br />~ ~ <br />,It, <br />e ~t, - rr tr. non.. ,ill 3 tit w;'-;z,., <br />for reservations°calh`1:800:hampton;onvlsdtus'online at w <br />n,u <br />n, <br />tt <br />, +m <br />. <br />ovw hainpton:6om. k <br />account no <br />date of charge <br />folio/check no. <br />9 <br />card mernber name <br />authorization <br />tmtral <br />establishment no and location establ,sh,nem agrees to transmit to card holder for payment <br />purchases &servlces <br />taxes <br />tips & mist <br />signature of card member <br />total amount <br />X 0 00 <br />.n ~ a n , n ~ I 1' ~ t7F„ronnu~ <br />a <br />