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Glass Casa CC Esign Document

Name on Credit Card:

Credit Card Number:

Card Experation Date: CCV2:

TOTAL AMOUNT TO BE CHARGED:

Reservation Number: Reservation Start Date: Reservation End Date:

By signing below I agree to pay the amount of the charges listed above. I have read, understand and agree to the Terms and Conditions set forth by Glass Casa for the above-noted reservation number and authorize Glass Casa to charge my card listed above for my vacation accommodations and subsequent charges.

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Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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Timestamp

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February 15, 2021 9:28 pm CDT

Glass Casa CC Esign Document Uploaded by Randy Bacik - randy@glasscasa.com IP 99.28.40.140