Third Party Authorization Form

Please complete and submit this form electronically and include a scanned copy of a government issued ID. Please ensure that the copy is legible, or we will not be able to accept it.

Your Name*

Please enter your name.

Person Checking In*

Please enter the guest's name.

Arrival Date*

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Departure Date*

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Total of Charges*

Please enter the total of charges.

Confirmation Number*

Please enter the confirmation number.

Charges to Apply*

Room & Tax OnlyGuest Incidentals OnlyAllOriginal Deposit Only

Please indicate which charges should be applied.

Credit Card #*

Please enter your credit card number.

Expiration Date*

Please enter the expiration date.

CVV Code*

Please enter the three-digit verification code from your card.

The 3-digit code on the back of your credit card.

Card Holders Billing Address*

Please enter the billing address.

Invalid Input

Town*

Please enter your city or town.

State*

Please select the state.

Phone*

Please enter the card holder's phone number.

Fax

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Email*

Please enter a valid email address for the card holder.

Driver's License or Passport*

Please attach a scan of your ID.

File must be less than 3MB and in JPG, PNG or PDF format.

Terms & Conditions*

I authorize The White Sands (aka 1106 Ocean Ave) to apply the charges of the above-named guest to my credit card. I understand that submitting this form will constitute a binding agreement for full payment for the above-specified charges as well as any damages incurred to room accommodations by guest or guest’s acquaintances.

Please accept the terms and conditions.