I hereby authorize Brasil Buzios Internacional Apart and/or its agency representative/wholesaler to issue any travel documents and charge one of my credit cards upon my verbal and/or written request.

American Express      Visa

Credit Card Number Sec. Code Exp.

For the purchase of services in the name of the following persons:

TOTAL AMOUNT USD

Name as appears on credit card

Billing Address:                                                                              Remarks:

SIGNATURE ________________________________________________________

Stay in an apartment in Rio de Janeiro
Stay in an apartment in Búzios Internacional Apart Hotel
Transfer from Rio de Janeiro to Búzios or vice-versa
Booking in an apartment in Rio de Janeiro or Búzios

PS: Please send a copy of front and back of the credit card and identification.

Av. Epitácio Pessoa 4476 – Apt. 1005 Bl. 1 – Rio de Janeiro (RJ) – Lagoa – CEP: 22471-003- Brazil  · Phone and Fax: 55.21.2537-3876

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