| I hereby agree that U.S. $_______ will be charged to my credit card as shown below. |
| Card Type: (Circle One): |
| Visa MasterCard American Express Diners Club Discover House charge |
| Credit Card Number: ________________________________ Expiration Date: ________________________________ |
| Card Holders Name: ______________________________________________________________________________ |
| Billing Address: __________________________________________________________________________________ |
| _______________________________________________________________________________________________ |
| E-mail Address: __________________________________________________________________________________ |
| Daytime Telephone Number of Card Holder: ____________________________________________________________ |
| Signature as on CC: |
| _______________________________________________________________________________________________ |
| Please print and fax to: + 345 949 0635 / Attn. Mr. Lazlo Boros Tel.: 1-345-949-9333 |
| Details for Issue of Gift certificate |
| Beneficiary of the certificate: ______________________________________________________________________ |
| Gift Certificate presented by: _______________________________________________________________________ |
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| Delivery Options: |
@ Presented on arrival at GOH – |
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@ Delivery in Grand Cayman within George Town area and 7mile beach free of charge |
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@ FedEx (U.S.$ 50.- delivery charges) |
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