Villacrè Mundo Viajes

PLEASE PRINT AND COMPLETE THIS FORM AND SEND IT BY FAX : +51(1) 248 0206

Pasaje Los Pinos 114
Miraflores (Lima - PERU)
T. + 511 248 - 0206
E. villacretours@hotmail.com

VISA & AMERICAN EXPRESS CREDIT CARD AUTOMATIC CHARGE FORM

CREDIT CARD NUMBER:

[ ][ ][ ][ ] - [ ][ ][ ][ ] - [ ][ ][ ][ ] - [ ][ ][ ][ ]

EXPIRATION: ___________ MONTH ___________ YEAR

OWNER NAME:

PASSPORT NUMBER:

COUNTRY:

ADDRESS:

PHONE: ( )_______________FAX ( )____________

E-MAIL:

TOTAL AMOUNT TO CHARGE IN U$A:

Automatic charge: The AMERICAN EXPRESS or VISA credit Card owner signing this form authorizes to charge

the total amount indicated for the travel services, in the account of the AMERICAN EXPRESS OR VISA CREDIT CARD

as mentioned.

CANCELLATION POLICY: All the cancellation will be 30 days before start the services requested.

The penalties for cancellation after that will be:

The cost for the first night and any expenses did for,
without refundable.

Administration charge.

As a sing of conformity hereby the credit card owner sign below,

SIGNATURE:

DATE: / /

PLEASE PRINT AND COMPLETE THIS FORM AND SEND IT BY FAX TO VILLACRE: +51(1) 248 0206

INCLUDING A COPY OF YOUR PASSPORT