To pay for your dream vacations, after you had contact us, you need to fill up this form, and fax it to this number (506) 2269-8930, you also need to attach copy of your credit card and your passport, we will confirm by phone or e-mail.

Click here for the printer friendly version.
Credit card authorization form
Full name        authorize to
charge to my credit card    Master Card           Visa            Amex        
 card number          Good thru     Month        Year
 
Credit Card Authorization ID:
 
Under the name of:       
 
The amount of US $
 
Write amount            
 
For the following services   

 

Please provide the following additional information:
 
Birth Date:

Day     Month Year   

 
Passport Number       Home Phone 
Fax Number                    Work Phone  
Email Address      
Home address      
Address to which credit card statements are sent (if is different from home address)

 

Signature             Day     Month Year   
 
IMPORTANT: Please attach Copy of Credit Card and Copy of Passport
   
 
 
 
 
 
 
 

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Costarrican Bussines ID ( Cédula juridica ) 3-101-507570
Tel # (506) 2269-8930
San José Costa Rica
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