Vieques Island Experience

RENTAL APPLICATION

Please indicate property:

_________Beach Bungalow _________Casa Mamey ___________Casa Loma

DESIRED RENTAL DATES_______________________  APPLICATION DATE__________

NAME ________________________________________________________________________

PHONE #___________________________ ALT. PHONE#______________________________

OTHER APPLICANTS 1) _________________________ 2) __________________________

3)_________________________________________4)_________________________________

5)_______________________________________6)___________________________________

IN CASE OF EMERGENCY, NOTIFY:

NAME________________________ADDRESS______________________________ZIP________

PHONE____________________

 PAYMENTS AND DEPOSITS

Please note that we accept Mastercard & Visa only!

NAME ON CREDIT CARD : _________________________________________________________

 MAILING ADDRESS: ___________________________________________________________________________________

 _____________________________________________________________________________________

_____________________________________________________________________________________

CREDIT CARD #: ____________________________________________________________________

EXPIRATION DATE: ____________________3-DIGIT VERIFICATION #_______________

CARDHOLDER’S PHONE #: _________________________________

EXACT AMOUNT TO BE CHARGED TO CARD: _______________