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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
(Cardholder's name as it appears on the credit card)
to charge $_______ on my VISA credit card. VISA 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 of the reservations 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.
I have read and accept the conditions specified in our Terms & Conditions page http://crtravelsite.com/html/terms.htm 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 Shuttle Service will be happy to supply cancellation information
for any
item on your itinerary
Photocopy of Credit Card (front and back)
Credit Card Holder's Signature:_____________________________ Date:______
Costa Rica Shuttle Service ,
Main Office San Jose, Costa
Rica
Telephone: (506) 2290-2878 / Fax: (506) 2290-2853