Incidental Form

Please complete form in BLOCK LETTERS

I, hereby authorize Coral Island Real Estate, trading as Barbados Sothebys International Realty of Elville House, Church Point, Holetown, St. James, BB24016, Barbados, West Indies, to debit my credit card as per details set below, for payment of:

NAME OF CARD HOLDER*
(As shown on credit card)

MAIN CONTACT IN PARTY*

PROPERTY*

DATES*

BILLING ADDRESS*

EMAIL ADDRESS*

TEL*

Please provide your credit card details below:

TYPE OF CARD*

VISA MASTERCARD

CREDIT CARD NUMBER*

EXPIRARTION DATE*

SECURITY NUMBER*

AUTHORIZATION USE FOR

DEPOSIT (BDS $)*

SECURITY DEPOSIT (BDS $)*

FINAL PAYMENT*

INCIDENTALS ON ISLAND

CARD HOLDER SIGNATURE*

Date*

*Please note that all transactions are made in Barbados currency and the exchange rates are as follows:
BDS $ 2.06 - Visa Card | BDS $ 2.06 - Master Card