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  To  Villacre Mundo Viajes SAC Pasaje Los Pinos 114 MIraflores Lima 18 - PERU Dear sirs, Hereby authorize I you explicitly to negociate via Procesos MC PERU S.A. the debit on my MasterCard credit card, in the concept and amount detailed as follow:

MASTERCARD CREDIT CARD AUTOMATIC CHARGE FORM

CREDIT CARD NUMBER:    [      ][      ][      ][      ] - [      ][      ][      ][      ] - [      ][      ][      ][      ] - [      ][      ][      ][    ]

EXPIRATION:  ________ MONTH _________ YEAR________VALIDATION CODE*_________

OWNER NAME:

PASSPORT NUMBER:

COUNTRY:

ADDRESS:

PHONE: (       )_______________FAX (     )____________

E-MAIL:

TOTAL AMOUNT TO CHARGE IN U$A:

*Note: the validation code appear printed on the back of the card, in the signature panel and after the number of the card. it have 3 digits. 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 done by VILLACRE, that were non 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