For your convenience, Boston Homestay Inc. can accept
either VISA or MasterCard credit card payments. Please PRINT a copy of this
page, complete the form and SCAN it back to Boston Homestay Inc. OR Call Boston Homestay at (617) 922-6326
Your Name: ___________________________
Home Address: ____________________________________________
City: _______________________, State / Region: ____________________
Postal Code: ________________, Country: __________________
Telephone Number:_____________________
--------------------------------------------------------------------------------
Check One: VISA_____, or MasterCard______
Name on Card
(if different from above):______________________________
Card Number: ___ ___ ___ ___ -- ___ ___ ___ ___ -- ___ ___ ___ ___ -- ___
___ ___ ___
Expiration Date
(format mm/yy): ___ ___ / ___ ___
I do hereby authorize
I agree to notify Boston Homestay Inc. directly should I have any intention of
extending my homestay beyond the agreed upon date. Furthermore, I authorize
Signature: ___________________________________, Date: _________________
Copyright © 1997-2018 by Boston Homestay Inc. All
rights reserved.