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✨ Wellness Experiences Payment ✨

Payment for your Relax & Rejuvenate at Pelican Waters Retreat

Please enter information on this form to make payment for Relax & Rejuvenate at Pelican Waters Retreat.

Name *

Phone *

Email *

Choose Package *

Retreat activities up to 6 persons - $550

Retreat activities 7 persons - $580

Retreat activities 8 persons - $610

Retreat activities 9 persons - $640

Retreat activities 10 persons - $670

Retreat activities 11 persons - $700

Please enter all participant names here *

Total Amount

$

Payment method

Square Card Payment

Billing Postcode*

Credit Card Number*

Expiration Date*

01 02 03 04 05 06 07 08 09 10 11 12 / 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036

Card (CVV) Code*

Card Type*

Visa MasterCard Discover American Express

Card Holder Name*

Credit or debit card*

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