CREDIT CARD AUTHORIZATION FORM
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Holder
Passport
Phone
Email
Address
I am pleased to give fully authorization to The Kupu Kupu barong Resorts and Spa by L'Occitane to deduct occurred from the :
Guest Name
Check in Date
Length Of Stay
Persons
Villas
Villas Rate
Total Amount
Remarks
To the following credit card
Holder
Number
Type
Exp Month
1
2
3
4
5
6
7
8
9
10
11
12
Exp Year
2023
2024
2025
2026
2027
2028
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