CentralAmerica.Com Credit Card Authorization Form
This form will NOT send your credit card information over the Internet. It simply allows you to print a filled in authorization form.
Step 1 - Type in information
(You can use Tab key to move to next box)
Step 2 - Drop file menu & click print		 Step 3 - Sign form at bottom
Step 4 - Fax to 1-888-726-9215
or 011-506-2243-1902
CentralAmerica.Com travel adviser you are working with:
I (cardholder's name) authorize CentralAmerica.Com, Inc.
to charge $ on the following credit card. Select one - Visa MasterCard American Express
Card #: Exp. Date: / CCV #: About CCV
Daytime Phone #: E-mail Address:
Street City State Zip
Mailing address credit card is billed to. (We can only send vouchers to billing address.)
Have you used us before? yes no // If not, how did you hear about us?

For Airline Tickets and Travel Insurance only: Please enter the first & last names of those traveling as they appear on travel documents to verify spelling. This must be filled in before tickets can be issued and Travel Insurance purchased. If the ticket does not match your passport name, the ticket will be invalid. I also agree to be responsible for the charges incurred on my card for the following persons.
Birthday      
First Name Middle Name Last Name Day Month Year
Once issued ALL Airline tickets are NON-REFUNDABLE/ NON-ENDORSABLE. All tickets MUST BE reconfirmed 72 hours in advance for each travel date. Change of date (s) or times once issued will incur a $100.00 penalty per ticket if applicable plus any difference in price.

MY SIGNATURE BELOW DENOTES MY ACCEPTANCE OF THE FOLLOWING:

TERMS AND CONDITIONS. - please read carefully -
**Due to limited availability, there are absolutely NO REFUNDS for unused services for any reason.
**Any changes in hotel reservations, car rentals, or tours incur a charge of $25.00 per supplier.
** All travelers are required to have a valid passport with at least 6 months left before the expiration date.
CANCELLATIONS other than airline tickets MUST BE RECEIVED IN WRITING and will incur the following penalties:
If received less than 15 days prior to departure, NO REFUND. / If received 15 to 21 days prior to departure, 50% penalty plus any supplier penalties. / If received 22 to 30 days prior to departure, 25% penalty plus any supplier penalties. / If received more than 30 days prior to departure, $50 plus any supplier penalties.
Because of the strict cancellation policies of most hotels in Costa Rica, we recommend travel insurance.
CentralAmerica.Com and its associates are acting as agents in selling travel related services or in accepting reservations for services. CentralAmerica.Com therefore is not responsible for any intentional or careless acts or omissions on part of such suppliers, which result is any loss, damage, delay or injury to cardholder, or those travelers paid for by cardholder. CentralAmerica.Com cannot be held responsible for any injuries, damages or losses caused to any traveler in connection with any actions outside of CentralAmerica.Com's control. By embarking, the traveler voluntarily assumes all risks involved in such travel, whether expected or unexpected. By signing below the cardholder consents to the above conditions and on behalf of all fellow travelers agrees to convey the contents of this agreement to all other travelers named above.

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 also acknowledge that discount International Airline tickets are NON-REFUNDABLE AND NON-ENDORSABLE.

Credit Card Holder's Signature:____________________________ Date:__________

CentralAmerica.Com - San Jose, Costa Rica - Tel: (506) 2243-1900 - Fax: (506) 2243-1901