Credit Card Authorization Form Please enable JavaScript in your browser to complete this form.Name *FirstLastLayoutEmail *Phone *Check-in *DateTimeCheck-out *DateTimeCredit Card Type *VisaMasterCardDiscoverAmercian ExpressCredit Card Number *LayoutExpiry Month010203040506070809101112Expiry Year2023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050CVV *Terms and Conditions: *I agree with Leader Motel's Terms and Conditions. No refund will be given if you fail to arrive or cancel the booking. Bookings are non-refundable and cannot be amended or modified. Full pre-payment is required for reservation. Your credit card will be charged immediately. You are responsible and liable for any breakages or damage which you and those that accompany you (whether they are staying in the motel or not) cause to the motel. While we do not typically charge for minor accidental breakages, we will charge for the total cost of all other breakages, missing items, and replacements. We ask that you please report any incidents as they occur. There is a $250 Room Recovery Fee for SMOKING inside the room, bringing a PET in bed, DAMAGING anything, REMOVING any items, and DISORDERLY CONDUCT. A $100 fee is charged if dishes and utensils are not washed before checkout. Makeup remover wipes & coloured face cloth towels are provided in each room to save white towels and bedding from permanent stains. There will be a $50 charge for each bedding and $14 per towel for replacements due to permanent stains caused by makeup, shoe marks, oil, grease, or blood stains. I agree that my liability for this bill is not waived. I understand that management reserves the right to refuse services to anyone and will not be responsible for any accidents, injury to guests or for loss of money, jewelry, or any valuables. There is a $40 charge if the key(s) are not put back in the key box and failure to follow the check-in/out instructions or house rules. By submitting this card as a payment method, you authorize approval to be secured on your account. We will charge the entire booking amount and a $400 hold for the damage deposit. Leader Motel will keep all information entered on this form strictly confidential. Card Holder's Signature *Clear SignatureDate Signed *NotesHuman Verification * = WebsiteSubmit Location 103 Highway 32 LeaderSaskatchewan, S0N 1H0, Canada Phone 306-628-4444 Email info@leadermotel.ca