Cocobay Credit Card REFUND Authorization Form

I hereby authorize Cocobay Resort to REFUND the card indicated in this authorization form according to the terms outlined below.

Name (As Shown On Credit Card):

First

Middle

Last

Reservation Reference No.

Credit Card Type:

Visa
Mastercard
Amex
Discover

Credit Card No.

Exp Date:

Security Code:

Amount US$:

Valid Proof Of I.D (Name on Card)

Drag & Drop Files, Choose Files to Upload

Authorized Signature:

Clear Signature

By signing above, I certify that I am an authorized user of this credit card and I will not dispute the charges with my credit card company, so long as the transaction corresponds to the terms in this form or Cocobay Terms & Conditions.

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