NAME:

NUMBER OF PERSONS

ADDRESS:

ARRIVAL DATE

DEPARTURE DATE:

NUMBER OF NIGHTS:

NUMBER OF ROOMS:

TEL:

FAX:

ROOM TYPE:

RATE: plus tax.

E-MAIL ADDRESS:

CREDIT CARD AUTHORIZATION FORM

DATE: I,

HERE BY AUTHORIZE HOTEL VERDE MAR

del PACIFICO S.A. to charge my VISA (  ) MASTERCARD (  ) ISSUE DATE

CARD NUMBER

EXPIRY DATE

IN THE AMOUNT OF:PLUS TAXES TO COVER THE FOLLOWING DATES

If I do not show up or if I cancel with less than 14 days notice, I agree that Hotel Verde Mar del Pacifico S.A. Has the right to full payment for the nights and rooms reserved. Rooms guaranteed by credit card will be charged upon check-in. EXCEPTIONS to this policy are Christmas, New Years and Easter weeks which cannot be cancelled once payment has been made. Christmas/New Years rooms must be prepaid on or before Nov 15th or at the time of booking. Easter rooms must be prepaid 30 days in advance or at the time of booking.

I have read and accept the conditions of the reservation and I agree to pay the amount herein authorized, even though I have notsigned the original charge note or voucher.

Signature as it appears on the card:

NOTE:  this form must be FILLED IN COMPLETELY and FAXED back to 011- 506-777-1311.  Please include a fax of an ID/document that includes your signature as it appears on the credit card.

ARRIVAL INFO:  BUS.  PLANE CAR

APPROXIMATE ARRIVAL TIME: FLIGHT NUMBER IF FLYING

PLEASE NOTE:  CANCELLATIONS MUST BE IN WRITING - BY FAX

PLEASE CALL AND ADVISE US IF YOU ARE ARRIVING AT A SIGNIFICANTLY
DIFFERENT TIME THAN ADVISED IN THIS INFORMATION.
P.O. Box 348-6350 Quepos, Manuel Antonio  Costa Rica Central America
Tel: 011- 506-2777-1805   Fax:  011- 506-2777-1311  Email: verdemar@racsa.co.cr  INTERNET: www.verdemar.com