Credit card order

I am agreeing to the terms of the non-refundable credit card payment by sending the following form.  I have phoned in my credit card
number and information for this payment.  If this payment is for a reservation deposit, it is non refundable.  If this payment is for rental
of the house or security deposit, it is non refundable.  I have read the Policy that is made a part of this agreement.

Please provide the following contact information:

Name
Work Phone
   
E-mail

Todays date

-- mm/dd/yy

Name of house you are renting and the Date of arrival?


I am placing the reservation deposit on the credit card I have called in (or the rent), and have read and agree to the Policy

Yes No

My full name (as appears on my credit card)


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Copyright © 2010 [Wild Coast Vacations LLC]. All rights reserved.
Revised: 05/25/11