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International
Credit Card - Charge Authorization
Form
Natival
Tours S.A.
San José, Costa Rica
Phone: +(506) 289-4292
Fax Numbers: +(506) 289-8591 or +(506)
215-3451
Electronic mail address:
info@costaricashuttle.com
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NOTICE!
Please fill out this form, print it
and send it by fax or email a scanned copy
in order
to complete your reservation.
IS MANDATORY TO ATTACH TO THIS FORM A
PHOTOCOPY OR SCANNED IMAGE
OF YOUR CREDIT CARD BOTH SIDES AND SEND IT
BY FAX (Above number) OR EMAIL ATTACHMENT
(Email address above).
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Date
(day/month/year):
[____/____/______]
I
[_______________________________________]
hereby authorize
(As it
appears on the credit card)
Natival
Tours S.A. to charge my Credit card
type
1. VISA mark with an X
[ ] / 2.
MASTER CARD mark with an X
[ ] / 3.
AMEX mark with an X
[ ]
Credit
Card number
[___________________________________________________],
Expiration
Date (month/year)
[____/______], Issue date
(month/year)
[____/______]
in the
amount of US$ __________._____ .Bank Code
(3 Digits Card ID) [______].
Concept of charges: Transportation
in Costa Rica, Central America. Final
method of payment
1.
Same credit card above mark with an X
[ ]
2. Cash or travelers cheques to the
driver mark with an X [
]
Credit Card holder's signature
Confirmation
number:[____________________]
I
have read and accept the terms and
conditions of the reservation and agree to
pay the amount here authorized, 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 7 days prior departure or
if I expressly chose this same credit card
information as my final method of
payment.
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