Credit Card Authorization Form
Please print, sign, and fax this form to +(506) 2290-2853 check with International operator which # you must dial to access Costa Rica (country code 506).
For security reasons for transmitting credit card information over the Internet, we have established this secure form of payment.
The following form must be filled out completely for us to accept VISA / MASTER CARD
I__________________________________________ authorize Turismo Expertos de
Costa Rica S.A.
(Cardholder's name as it appears on the credit
card)
to charge $__________________________ on my VISA / MASTER CARD credit card.
VISA/MASTER Card #
_______________________ Exp. Date ______Issuing Bank _______________
Passport #_________________
Date of birth ____________Mother's maiden name ________________
Address
______________________________________________________________________________
Address on Visa Acct. (if
different) _______________________________________________________
Daytime phone #_________________ Fax #:________________ E-mail Address:__________________
I have read and accept the conditions specified in our Terms & Conditions page http://www.onecostarica.com/terms_and_agreements and I agree to pay the amount here authorized, even though I have not signed the original charge note or voucher. I agree to pay this amount in case of "No Show". I understand that, in case of cancellation, I am responsible for all penalties charged by individual suppliers and by Costa Rica Travelsite.
Costa Rica Travel Site will be happy to supply cancellation information for any item on your itinerary
Photocopy of Credit Card (front and back)
(can use additional pages for photocopies)
Credit Card Holder's Signature:___________________________________ Date:________
Costa Rica Travel Site, Telephone: +(506) 2290-2878 / Fax: +(506) 2290-2853
(can use additional pages for photocopies)