La Colina Lodge Monteverde Reservation Form

La Colina Lodge
Monteverde
C.R. (506)-2645-5009
C.R. Fax (506)- 2645-5580
U.S. 435-627-8386
U.S. fax 435-627-8386
Email: info@lacolinalodge.com

Guest(s) Name: ___________________________________________________
Country: _____________________________
Passport#: ________________________________
Contact Phone Numbers: ____________________________ (home/work/cell/other) ____________________________ (home/work/cell/other)
Email Address: _____________________________________________
Arrival Date: _______________________________________________
Checkout Date: _____________________________________________
Number of Guests: ___________________________________________
Shared/Private Bath: __________________________________________

Method of Payment:
Credit card: Visa _____ Mastercard _____ Amex_____ Discover_____ Paypal_____

Credit Card Number: _______ - _______ - _______ - _______
Exp. Date:_______ MM/YY

Cardholders Name: ________________________________________________
Please PRINT name exactly as it appears on card

Cardholders Signature: __________________________________________


A deposit of one night's lodging is required to confirm your reservation. Your deposit is non-refundable. Cancellations or changes to your stay made 15 days prior to arrival date will not result in a charge beyond your deposit. All cancellations must be emailed or faxed (you must retain your fax confirmation). Claims of phone calls will not be honored.