Fax Request for Confirmed Hotel Reservations
Samara Beach, Guanacaste, Costa Rica

1. Complete ALL fields on the form below.
2. Print this page.
3. Sign at the bottom of the printed page.
4. Fax the page to the Hotel where you are requesting Guaranteed Reservations.

This Authorization Covers The Services Outlined Below:

To:  
 

 
Today's Date:  
Description:  
Amount Total:  
Card Type:  
Card Number:  
Expires:  
Card Holder Name:  
Billing Address:  
Telephone:  
Fax:  
E-Mail:  

Cancellation and no-show refund policy:
  • Full refund for cancellations made more than 15 days prior to reservation date.
  • 50% refund for cancellations made 7 to 14 days prior to reservation date.
  • No refund for no-shows and cancellations made less than 7 days prior to reservation date.
I hereby authorize the recipient of this form to charge my credit card for confirmed reservations.

Authorized Signature:

X