VISA
CREDIT CARD AUTHORIZATION FORM 
All reservations require a Deposit to
Guarantee a Reservation and Confirm your Booking.
MasterCard
  Date:   Passport #:

  Country:


  I,

Print Full Name as shown on Credit Card
 Telephone:

  Fax / Cell:Fa

Authorize AparHotel Vista Pacifico, (GreJanBerTil S.A., Jaco, Costa Rica)
to charge my Credit Card

  DEPOSIT Amount in US $


  VISA / MasterCard Number:

Please indicate which card you are using.

  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)

X
 

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 info@vistapacifico.com

       
Arrival Date
Departure Date
Type of Room / Number
Total Amount in $ US

www.vistapacifico.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

info@vistapacifico.com

HOMERates & Room DescriptionsReservationsPhotosDay TripsCONTACTBooking Calendar


C O U N T E R S