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:

Contact - Step 1 of 3

Phone

Reservation Reference No. (If Available)

Name (As Shown On Credit Card):

First

Middle

Last

Credit Card Type:

Credit Card No:

Security Code (CVV):

Billing Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name

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