Cardholder Name (as shown on card) ____________________________________
Address:___________________________________________________________
Work Phone_______________________ Home Phone ______________________
Credit Card type (Visa or Master Card only) and #:___________________________
Expiration date:____________________Amount Charged _____________________
General Description of Charge:
VERY IMPORTANT NOTICE:
These travel items are being pre-purchased by you and are now subject to
change fees
and/or cancellation penalties. These fee amounts are at the discretion of
the various
operators and hotels. If you do not use any travel items, for whatever
reason, it is likely
that a cancellation fee will apply against any refund that may be due you.
Contact us for
details relating to your specific package. Depending on the circumstances,
travel insurance
may or may not cover some or all of such costs.
WE STRONGLY RECOMMEND PURCHASING TRAVEL INSURANCE:
Travel Insurance provides financial coverage for MOST unexpected
occurrences such as
sudden illness, injury, or death of self, traveling companion or immediate
family. It
provides medical coverage during the trip, pays for lost baggage,
inclement weather, etc.
Some restrictions apply. IF TRAVEL INSURANCE IS PURCHASED WITHIN 10
DAYS OF PAYING INITIAL TRIP DEPOSIT, ALL PRE-EXISTING MEDICAL
CONDITIONS ACCEPTED. Go online to
TRAVELEX
or
call 1-800-228-9792 and mention
the ID number 43-6065 to purchase
travel insurance or for specific questions about insurance. Make sure you
insure all of
your travel expenses for the entire trip (airfare, accommodations, day
trips).
I
acknowledge being offered travel insurance.
I am __________ I am not
_______________ purchasing it as part of this package.
PLEASE
INDICATE
YOUR
CHOICE ON TRAVEL INSURANCE ABOVE.
I hereby authorize Travel Innovations or their agent to charge my credit card the above amount for the travel package generally described herein. I agree that I may only dispute this charge if not supplied with the goods and services now being paid for and described above.
SIGNED________________________________ DATE ________________________