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,	_______________________________
or American Express Acct #:	_______________________________
4 digit security code (for AMEX only):	_______________________________
Expiration Date:	_______________________________
Amount to be charged in Belize dollars:	_______________________________
Name on card:	_______________________________
Name of Issuing Bank:	_______________________________
Arrival date:	_______________________________
Departure date:	_______________________________
Nights of stay:	_______________________________
Amount Charged	_______________________________
Email address:	_______________________________
Contact number:	_______________________________
Signature and Date:	_______________________________

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Reservations can only be secured upon payment of 1 night’s stay for each room reserved.
Payments by credit card can be made in the lobby, or by phone or fax. Do not send your credit card information via email.
100% refund will be issued for reservations that are cancelled at least 48 hours BEFORE your arrival date.
No refunds will be issued if reservations are cancelled WITHIN 48 hours of your arrival date.
No refunds for early check out.

BZD $1.00=USD 50 cents