The Jungle Villa, as seen on http://www.JungleVilla.com, located on a private estate in Manuel Antonio, Costa Rica will be occupied by Me, (Name) _____________________________________________ and _____ guests (incl.children) For a total rental price of .. US$, for a period of .. nights Check-in date: Check-out date: In consideration for this "Rental Period", I will pay by Visa/Mastercard credit card, 50% of the rental price which is $ .. and agree to pay the remaining $ .. at least 30 days prior to the first date of occupancy. 50% Deposit due within one week from date of booking to confirm reservation. Cancellations made 60 days or more prior to arrival may be applied to an alternate booking date. Cancellations made less than 60 days prior to arrival will result in complete loss of deposit, unless part or all of the dates can be rented to another party by management. The Jungle Villa and its owners are NOT responsible for any injuries and/or personal liabilities incurred by guests of the property. Please get the very best Travel Insurance! 1. Visa/MC Card Number: __________________________________ 2. Exp.Date: ______ 3. Name on Card: _________________________________________ 4. CVV2/CVC2 ______ (Security Code) 5. Billing Address: __________________________________________________________ City _____________________________________ State: ________ Zip: ___________ 6. Phone Number: ____________________________ Email: _________________________ I certify I am the bank authorized signer/cardholder for the above account and agree that European Travel Network (ETN) can charge my account for the Rental Price of JungleVilla.com I understand my credit card will show this charge as: ETNPAYMENTS.COM PANAMA ________________ __________________ ___________________ FAX THIS COMPLETED AND Name Nationality Passport Number SIGNED FORM TO USA FAX 1-305-760-4681 ________________ __________________ ___________________ Signature Date Place