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Glass Casa Credit Card Authorization Form
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Name on Credit Card
*
Enter the name of the credit card holder
Email Address
*
Credit Card Number
*
Card Experation Date
*
CCV2
*
Enter the three-digit security code on the back of the card
TOTAL AMOUNT TO BE CHARGED
*
Reservation Number
*
Enter your Glass Casa reservation number. Your reservation number can be found in the upper right-hand corner of your reservation confirmation
Reservation Start Date
*
Reservation End Date
*
Continue to E-signature