Last Stop Sports

Fishing License charge authorization form

Charter Company: ______________________ Charter Start Date:________________

Month  /  Day  /  Year             

Charter Booking Name: ________________________________________________

Applicant Name/s:  ____________________________________________________

                                ____________________________________________________

I hereby authorize Last Stop Stop to charge $______ USD to my credit card

$55 per License ($45 for the BVI Government plus $10 for LSS)

V/MC #________________________________________________  Exp:___________

Discover #______________________________________________  Exp:___________

Print Name:________________________________________________

Signature:_________________________________________________

We will charge your card and process your application a few days before arrival.

After your application has been processed, there will be no refund.

Please fax the form to number: (284) 494-0593