Reservations Request / Payment Information Form
If you have not yet submitted an availability request, click here:
Email: dclark@thepalmscostarica.com / Call: (506) 2-735-5012
Please print, complete and fax the following form to:
FAX THIS FORM TO:
(506) 2.735.5028

Today's Date:
____________________

Name: ______________________________

E-mail: ______________________________

Phone Number: ______________________

Fax: _______________________

Room Type: ____________________________
Please refer to the rate card on the right >>

Number of Adults:_____________

Children: ____________________

Arrival Date: ________________

Airline: _____________________

Flight #: ____________________

Time: ______________________

Preferred Contact Method:
Email___   Phone ___

RATES / ROOM TYPES:
High Season: November 1st thru April 30th

Rates: $65.00 for Beachfront Rooms
$30.00 Garden Style/Backpacker Style rooms

Green Season: May 1st thru October 31st
Rates: $45.00 for Beachfront Rooms
$30.00 for Garden Style/Backer packer Style rooms

* Room costs do not include the 16.39% hotel tax
** Please contact us for special group rates.

Departure Date: ____________________

Airline:____________________________

Flight #:____________________________

Time:______________________________

Credit Card Authorization:
I authorize Inversiones Ama Jaguraes S.A. dba as The Palms to charge my Visa or Master Card, and additional amounts pursuant to our Payment / Cancellation policy below. This card will only be charged after verification of your reservation request has been completed and you have given approval of the final rate.

Cardholder Name: ________________________________________
Visa or M/C Number: ______________________________________
Passport #: ______________________________________________
Expiration Date: __________________________________________
Passport Exp. Date: ______________________________________
Cardholder Signature: _______________________________________________

Payment / Cancellation Policy: If you are coming to The Palms more than 45 days from the date of making your reservation, we will charge your credit card 50% upon receiving your Reservation Confirmation, and the other 50% 45 days prior to your arrival. If you are coming to The Palms in less than 45 days, we will immediately charge your credit card the full amount owed for your stay here at The Palms. Meanwhile, we will continue to work on your special requests, such as flights, hotels, etc, and keep you informed regarding these matters. Remember, we have limited space so make your reservation as far in advance as you can. Cancellations must be received 45 days prior to your check in date to avoid losing your deposit.