Last Name *
First Name *
Accompanying person

age (in case of children) years

age (in case of children) years
Complete Adress *
City*
ZIP CODE*
Telephone number *
 country code. / area code / number
Fax*
 country code. / area code / number
E-Mail ***

Hotel of Choice*
 Hotel Atlantico Other Hotel Option
Arrival Date *
 mm / dd
Departure Date *
 mm / dd
Type of Room *
 Single room Double room Twin Room (two separate beds)
I authorize Hotel to debit to my Visa Diners Mastercard Amex credit card *
Credit Card Number *
Security Code *
Valid Until *
 mm / yyyy

including additional 5% for taxes, equivalent to:

Full payment of the above mentioned hotel reservation

Hotel reservation + roundtrip Rio/Buzios/Rio transfers.
Notes for reservation: Please send this form via fax 55 21 3325 1038 or e-mail brazil@brazildestination.com.br together with the copy of the credit card (back and front).

I declare I read and agree with all the above conditions for hotel reservation, including cancellation policy and deadlines.

Please check all information before send. Thank you for choosing Brazil Destination.