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CREDIT
CARD AUTHORIZATION
FORM All reservations require a Deposit to Guarantee a Reservation and Confirm your Booking. |
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| Date: | Passport #: |
Country: |
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I, |
Telephone: Fax / Cell:Fa
Authorize AparHotel Vista Pacifico, (GreJanBerTil S.A., Jaco, Costa Rica)
to charge my Credit Card
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DEPOSIT Amount in US $ |
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VISA / MasterCard Number: |
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VISA / MasterCard Card Expiry Date: |
P L E A S E P R I N T
I hereby agree as the "Conditions of Reservation" to pay the amount here authorized as a "Deposit" to guarantee my reservation even though I did not sign the charge note original voucher. I hereby authorize Vista Pacifico AparHotel to charge the "Deposit" to my Credit Card and if I cancel or do not arrive at the hotel on the reservation date or do not stay for the reservation period there shall be no refund.
Fax Signed Form to 011 (506) 2643-2046 or E-mail Scanned & Signed PDF / JPG / TIFF / BMP / XLS /Word doc.
Signature
(Exactly as on Card)Please note which card you are using: Visa - MasterCard.
Print this form - Fill it in with a Signature and Fax to 011 (506) 2643-2046. or
E-mail a Signed PDF / JPG / TIFF / BMP / Word doc to janandgreg@vistapacifico.com
| Arrival
Date |
Departure
Date |
Type
of Room / Number |
Total
Amount in $ US |
www.
.com
Hotel VISTA PACIFICO, Apdo 108-4023,
Jaco, Puntarenas, Costa Rica •
Tel: 011 (506) 2643-3261 • Fax: 011 (506) 2643-2046
GreJanBerTil S.A.• Lomas de Jaco • Ced.
Jur. 3-101-270858 • ICT 611-136 • IV 3-120-056802-28
