x Credit Card Authorization Form
Credit Card Authorization Form

Credit Card companies operate under different regulations in Costa Rica and our credit card processor requires that we have your signature on file. We apologize for this inconvenience.

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 - Fill in information
Step 2 - Drop file menu & click print		Step 3 - Sign form at bottom
Step 4 - Fax to 1-866-788-2994

Name
(as appears on card)		 Visa Master Am Ex
Credit Card # Exp. Date
Daytime Phone # Fax #
E-mail address
Centralamerica.Com Agent______________________________________
Mailing address credit card is billed to. (We can only send vouchers to billing address.)
Street City State Zip
I authorize a charge of $50.00 to the above credit card as a deposit for confirming availability and making reservations. I understand that charge will not be processed unless I cancel after these reservations have been made.
Credit Card Holder's Signature:_____________________________ Date:______

Centralamerica.Com - San Jose, Costa Rica - Telephone: (506) 243 1900 - Fax: (506) 243 1901 / (506) 243 1902

When your reservations are confirmed you will be sent an authorization form for the total amount.