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RESERVATION
CREDIT CARD
AUTHORIZATION FORM |
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Date: _____________________ |
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Client's Name:
______________________________________ Phone:
________________________ |
| Address:
_____________________________________________ Fax:
__________________________ |
| Country:
__________________ E-mail: ____________________________ |
| ID or
Passport Number: _______________________________ Number of
People: _____________ |
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Tour Requested:
___________________________________ I
_______________________________ |
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Authorize Bella Brasilito S.A., to charge my Visa Card number:
__________________________ |
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Expiration Date: _________________ in the Total Amount of: US$
_________________ |
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Please complete all information, sign it and fax this form to Bella
Brasilito S.A., fax number (506) 257-6272 in order to confirm the
reservation. Please send us a copy of your credit card front and
back.
( IF BY ANY REASON YOU CAN NOT TRAVEL, WE REFUND 70% OF THE
DEPOSIT ) |
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Signature
__________________________________ |
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