Credit Card Charge Authorization

This charge authorization form will NOT send your credit card information over the Internet. It will allow you to print out a Universal Credit Card Authorization Form. After completion please sign it and send it by fax to 816 531-7805.

CREDIT CARD FORM, FOR THE EXCLUSIVE USE OF
Absolutely Costa Rica, Gina Tamasi

Please bill my credit card for the outlined services below:

DATE	DESCRIPTION	AMOUNT US$





	TOTAL US$

Cancellation and no-show policy: No refund will be issued for no-shows or cancellations made less than ten days prior to the reservation date. A 50% refund based on all outlined services will be issued for cancellations made ten to 15 days prior to the reservation date.
A full refund minus a $100 administration fee, will be issued for cancellations made more than 15 days prior to reservation date.

I hereby authorize Absolutely Costa Rica to charge my credit card
for confirmed reservations as outlined above.

Card Holder Name:
Card Number:
Expiration Date:
Telephone:	Fax:
E-Mail:
Billing Address:
Authorized Signature:	Don't forget to sign!

Please fax this form to the U.S. at (816) 531-7805