Date:__________________________________________________________________________________________

Client’s Name:________________________________________Phone:___________________________________

Address: ______________________________________________Fax:____________________________________
 
Country: _____________________________________________eMail:__________________________________

Number of People : ___________Room: 1 ... 2 ... 3  ... 4  ... 5  ... 6 ... House

Hotel: _______________________________    In: ____________________ Out: __________________________        

                                                                                                                            
I_______________________________________ authorize Hotel Villas de la Selva to charge my (Visa 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)

The full amount will be changed to the credit card in the moment of the reservation.
Please send us a copy of the both sides of your credit card.

by signing this document, the client agrees to be bounded by V.D.L.S conditions, regulations and conditions without any appealing

signature

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