Please print this form and fax it to Costa Rica at: dial +(506)2479-1400 U S A Fax: 225-208-8950

I, ______________________________________ here by authorize Erupciones Inn

to charge the ammount of: $____ on my Credit card Visa Or Mastercard only


CREDIT CARD: VISA Mastercard

Day in____________________________________

Day Out__________________________________

Type of Room_____________________________

Number of People_____________________________

Number of Rooms________________________

CREDIT CARD NUMBER:________________________.

EXPIRATION DATE:___________________________.
Issue Date _________________________________
Bank Code__________________________________

SIGNATURE:________________________________.

Please Sign here with the same signature on the Credit Card that you provide to secure the reservation

I have read and accept the conditions of the reservation and agree to pay the ammount here authorized
even though I have not signed the original charge note or voucher.
I agree to be charge the total ammount of my reservation in case of ¨No Show¨or Cancellation.
There is not Refund for cancellations Received whiting 15 days of reservation date:

your credit card will not be charge except for the above reasons.
All payments are due on Service Date.