Reservation Toll Free: 1-888-790-5264

CREDIT CARD PAYMENT - SIGNATURE ON FILE

Date: Quito, 2006
 
Dear Sirs
Banco del Austro
Quito.-

On behalf of:
I, with ID card number
authorise that Termas de Papallacta debits my credit card VISA MASTERCARD
with the sum of USD $
..................................................................please write sum in words
Credit card number:
Expires: Month: Year:
Security code:
 
Yours faithfully,
 
Signature
 
Tel:
Address:
 
Please note:
Please attach a photocopy of credit card (front and back)
Fax: Termas de Papallacta: 2549794
 
Quito Reservation Office: Foch E7-38 y Reina Victoria 4th floor
Tel: (593-2) 2568-989 / 2504-787 / 2230-156 Fax: (593-2) 2549-794 Cel: (593 9) 9701-621
Thermal Spa & Resort: (593-6) 2320-620/21/22 (593-2) 6005 586 / 87 / 88 / 89 / 90 Fax:(593-6) 2 320 622 ext. 119
Cel: (593 9) 2753-079
Email: termasuio@termaspapallacta.com