Tico Adventure Lodge
Fax Request for Confirmed Hotel Reservations
Samara Beach, Guanacaste, Costa Rica

1. Complete ALL fields on the form below.
2. Print this page.
3. Sign at the bottom of the printed page.
4. Fax the page to Tico Adventure Lodge ~ Fax: +506 2656-0996

This Authorization Covers The Services Outlined Below:

To:  
 		 Tico Adventure Lodge
 
Today's Date:  
Description:  
Amount Total:  
Card Type:  
Card Number:  
Expires:  
Card Holder Name:  
Billing Address:  
Telephone:  
Fax:  
E-Mail:  

Cancellation and no-show refund policy:
  • Full refund for cancellation made 30 days before arrival date.
  • 50% refund for cancellation made 15 to 30 days before arrival date.
  • No refund for cancellation made less than 15 days before arrival date or no-shows.
I hereby authorize the recipient of this form to charge my credit card for confirmed reservations.

Authorized Signature:

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