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 *

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