Annual Voucher Pre-Payment Form

Affiliate Number

Chairman's Circle – please enter your affiliate number sequence as follows: 01-CC-123 for Box A, B, and C.
Chairman's Circle Samana Elite – please enter your affiliate number sequence as follows: 01-SE-123 for Box A, B, and C.
Owner Circle – please enter your agreement number sequence as follows: 01-OC-123 for Box A, B, and C.

Box A

Box B

Box C

Box D

Affiliate Name:

Accommodation:

Arrival Date:

Check-out Date:

Email:

Confirmation Number:

All inclusive rates #1

Affiliates #1

Rate:

Start Date:

End Date:

Guests #1

Rate:

Start Date:

End Date:

All inclusive rates #2

Affiliates #2

Rate:

Start Date:

End Date:

Guests #2

Rate:

Start Date:

End Date:

Traveler Names

(every person travelling in group)

Affiliate/ Guest

Adult

12+

Child

3-12

Infant

0-3

Check-in Date

Check-out Date

Rate 1 (USD per night)

# nights of All inclusive rate 1

Total rate 1

Rate 2 (USD per night)

# nights of All inclusive rate 2

Total rate 2

Grand total all inclusive

Amount Authorized from Voucher

Pay on arrival

(Non-voucher only)

Band Color

Please fix the following errors in the table:

I authorize the use of my annual voucher to pre-pay the all-inclusive for the guests detailed above in the amount of

By authorizing the above amount I agree that should the number of guests decrease,or the duration of their stay change, I will not be refunded the difference in all-inclusive. I confirm that if more guests arrive, or people other than named above, they will be charged $200 per day and issued with non-vip bracelets for the duration of their stay.

Affiliate Name

Date

This form must be received a minimum of 7 days prior to check-in, anything received less than 7 days will be ignored and you will not be able to use your Voucher to use towards your all-inclusive.