For: Jardel Tourism

From: Pousada Literária de Paraty

DEBIT AUTHORIZATION

I authorize and acknowledge the

debit in my credit account with the
data provided below for payment of
the service to be provided:

CREDIT CARD:

(x) MASTERCARD

CARD NUMBER: 5216 6418 7448 0528

CARD HOLDER (AS ON CARD): MF JARDEL TOURISME
CARD VALIDITY: 02/24
SECURITY CODE: 958
DEBIT AMOUNT: BRL 29.056,50

CLAUSES:
By authorizing the debit on the credit
card, the holder of the associated card
and establishments declare to be
aware of and agree with the following
conditions:

1- The establishment and its

intermediaries are responsible for the
correct acceptances, checking the
validity, authenticity and signature of
the cardholder when presenting the
card.

2- If the services are provided on

behalf of people other than the
cardholder, their names must be listed
below, for greater security for the
member:

3- Please send a copy of the front and

back of the credit card.
_________________________________
CARD HOLDER SIGNATURE

Pousada Literária (24) 3371-1460

(24) 3371-1568
Rua do Comércio nº 362 Centro
Histórico - Paraty-RJ
www.pousadaliteraria.com.br