Date:__________________________________________________________________________________________

Client’s Name:________________________________________Phone:___________________________________

Address: ______________________________________________Fax:____________________________________
 
Country: _____________________________________________Email:__________________________________

Number of People : ___________Room: I ... II... III ... IV ... V ... VI ... House

Hotel: _______________________________    In: ____________________ Out: __________________________        

                                                                                                                            
I_______________________________________ authorize Hotel Villas de la Selva to charge my (Visa, Amex or MC)

Card Number:___________________________________________  Issue Date:________   Exp. Date: __________

Bank Code: ___________________ (applies only to Amex cards. Appears on right side of line next to card Num)

I understand that this credit card will be charged 50% + tax 30 days before my Room date unless I deposit the 50% directly into the Villas Hotel account (please ask for details).  This deposit can only be refunded if reservation is cancelled
in writing one month or more prior to arrival.

I understand that this credit card will be charged the full amount of my Room if my reservation is made within 1 month of my date.
 
The client must complete all information, fill in the total amount the Rooms, sign it and fax this form to Hotel Villas de la Selva within 24 hours of receipt of this form in order to confirm the reservation. 
Please send us a copy of your credit card front and back.

By signing this document, the client agrees to be bonded by Hotel Villas de la Selva regulations
and conditions without appeal.