|
 |
|
|
| |
| Credit Card Deposit Form |
please note: visa and mastercard international will add a 2-3% currency conversion fee to your charge amount. your credit card issuer may add on an additional percentage. we process your charge at ants over that authorized below. credit card deposit form information requests credit card authorization form letter of authorization to charge credit card i authorize destinations belize to charge toging, transportation or purchase of products in the amount of: $___________________ u.s. dollars ($1 usd = $2.00 bzd) card holder's name on card: ______________________________________________ credit______ exp. date:___________ cardholder's contact information, including billing address: street address: ___________________________________________________________ suite/apt. no.:_______________________________ state/province/district: _____________________________________________________ country: _________________________________ zip code:_______________________ billing_______________ alternate fax: _________________ email address: ___________________@_______________________________________ signature:_________________________________________________________________ belize general delivery point placencia, stann creek district belize, central america us fax: 1-603-452-4797 belize phone: 501-523-4018 belize cell phone: 501-610-4718 us phone: 314/776-6166
http://www.destinationsbelize.com/credit.htm - 4k
|
 |
http://www.destinationsbelize.com/credit.htm
2005-12-03 23:29:35
|
|
|
|
|
|
