Please print the below form by clicking on the printer icon in the upper right hand corner of this page. Upon completion, please fax to (970) 453-4284.

I, the undersigned, authorize the Beaver Run Resort and Conference Center to use the
specified credit card as payment for the following charges‚

____________________________________________________
Print Name on Card

____________________________________________________
Organization/Company Name

Account________________________________Expiration __/__


Cardholder's Signature

Billing Contact Phone ___________________________________

Conference Name:_______________________________________

Name on Reservation:_____________________________________


Arrival Date: _____________ Departure Date: __________________

Please check all that apply:
Food & Beverage $_______________
Meeting Room Rental and Audio Visual Requirements $_______________
Guest Room and Tax Only $_______________
Guest Room Charges Including Incidentals $_______________
Other ________________________________ $_______________

Upon completion of this form, please fax to 970/453-4284.

Thank you for choosing Beaver Run Resort!