E-mail Address: (required)
Verify E-Mail Address:
Your Name:
Date of Arrival:
Date of Departure:
Number or guests:
Number of rooms:
Type/# of Bed(s):	King Queen Twin
Quito - Cusin transfer?*	Yes	No
Spanish classes?	Yes	No
Itinerary assistance?	Yes	No
Galapagos Cruise?	Yes	No
Amazon Lodge?	Yes	No
Cloud Forest Lodge?	Yes	No
Special requests:
*All flights can be met at Quito's international and national airports by new vehicles. 1-6 guests, $90. 12 seat bus, from $190. Did you include your e-mail address?

A reservation is secured by a first night payment in $USD for all rooms requested. The security deposit is non-refundable and transferable for one year from the reservation date.

Payment options:

• Via Paypal to the account of haciendacusin@aol.com:

• A $US check made to Casamolina, Inc. and mailed to Casamolina, Inc., 53 East 66th Street, New York, NY 10065.