Cocobay Credit Card PAYMENT Authorization Form

I hereby authorize Cocobay Resort to CHARGE 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. (If Available)

Credit Card Type:

Visa
Mastercard
Amex
Discover

Credit Card No.:

Exp Date:

Security Code (CVV):

Amount US$:

Upload Valid Photo ID of Card Holder

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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.

Phone

Your credit card details are encrypted and processed securely. We never store your payment information.