Credit Card Authorization Form

I, hereby authorize Hotel de la Fuente of Orange Walk Town, Belize, to charge my credit card in accordance with the reservation policy listed below.

Visa, MasterCard,	_______________________________
Expiration Date:	_______________________________
Amount to be charged in Belize dollars:	_______________________________ (1 night's stay)
Name on card:	_______________________________
Name of Issuing Bank:	_______________________________
Arrival date:	_______________________________
Departure date:	_______________________________
Nights of stay:	_______________________________
Email address:	_______________________________
Contact number:	_______________________________
Signature and Date:	_______________________________

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Other countries Fax: International code +501-322-3651

The information above is held as security only. No charges will be made until your arrival.
Do not send your credit card information via email. Send authorization information by phone or fax.
There is no charge for reservations cancelled at least 48 hours before arrival date.
1 night’s stay will be charged for reservations cancelled less than 48 hours before arrival date.
No refunds for early check out

BZD $1.00=USD 50 cents