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Cinco Hormigas Rojas

Traveler's Refuge

Fax number 011-506-2257-8581

Credit Card Authorization

I (name)____________________________________________________________________________
           authorize Mayra Güell Meza from Cinco Hormigas Rojas Bed & Breakfast to charge my

Visa______________________ Master Card_____________________ Amex_____________________

Name as it appears on the card_________________________________________________________

Card number___________________________________ Issue date ____________________________

Expiration date ________________________________ Amount of $ ___________________________

This charge is for the room reservation of

Number of nights_________  Check in date ____/ ____/ ____  Check out date ____/____/ ____

Cost per night $______________ TOTAL $ __________________

 

Signature ____________________________ Passport number ________________________________

Thank you,

Mayra Güell, Owner