CREDIT CARD AUTHORIZATION FORM
apart@buziosbeach.com.br        www.buziosbeach.com.br

I hereby authorize Brasil Buzios Internacional Apart and/or its agency representative/wholesaler to issue any travel documents and charge one of my credit cards upon my verbal and/or written request.

American Express      Visa

Credit Card Number Sec. Code

Exp.


For the purchase of services in the name of the following persons:

1.

 

AMOUNT USD

2.

 

AMOUNT USD

3.

 

AMOUNT USD

4.

 

AMOUNT USD

 

 

 TOTAL AMOUNT USD R$

Name as appears on credit card

Billing Address:                                                                              Remarks:

Street:

 

 

City:

Estate:

Zip Code:

Country:

ASSINATURA ________________________________________________________

Stay in an apartment in Rio de Janeiro
Stay in an apartment in Búzios Internacional Apart Hotel
Transfer from Rio de Janeiro to Búzios or vice-versa
Booking in an apartment in Rio de Janeiro or Búzios

PS: Please send a copy of front and back of the credit card and identification.

Av. Epitácio Pessoa 4476 - Apt. 1005 Bl. 1 - Rio de Janeiro (RJ) - Lagoa - CEP: 22471-003- Brazil  · Teléfone y Fax: 55.21.2537-3876

Print this page