CHARGE AUTHORIZATION FORM INTERNATIONAL
CREDIT CARD
Transport Costa Rica M. E-mail:
info@transportcostarica.net
Fax: + (506) 2645 6315
Date:
________/_____/______
Visa
[ ]
MasterCard
[ ] American Express
[ ]
Month /
day / year
Name ___________________________________
(As
it appears on the credit card)
I hereby authorize to Transport Costa Rica Monteverde S.A. to charge my credit
card type, for transportation service in Costa Rica.
Reservation # ___________
Credit card number ____________________________________________.
Valid thru date _____/_____.
Charge a cost of US $ _____________.
(month / year)
Write amount in letters:_____________________________________
dollars
I
accept the terms and conditions of the transport reservation and agree to pay
the amount here authorized or the amount equivalent in colons Costa Rican, even
though I have not signed the original voucher, in case of I don't show up the day
of the service or if I cancel the service within the term five days before the
service transport.
NOTE :
Please fill out this form, print it and send it by fax
# + (506) 2645 6315
or email
a scanned copy
in order to complete your reservation.
E-mail:
info@transportcostarica.net
