Signature on File Form

I authorize COSTARICAN WONDERS S.A. to charge, by touristical services that I will

receive in Costa Rica, the amount of US$

to my credit card

Number

Valid thru .

Cardholder Name:________________________________________________________.

Telephone:______________________________________________________________

Fax:____________________________________________________________________

Email Address:___________________________________________________________

Signature:___________________________________

Date:_______________________________________

¡ IMPORTANT !
*** DO NOT E-MAIL THIS FORM***
Fill out all the information, print it out and fax it to +(506)-227-04-76, with a copy of your credit card and a legal document where your signature is shown.

Costarican Wonders S.A.
Travel services