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Offer of Travel Insurance
This form is required and it verifies that you have been offered Travel Insurance and will document your decision to purchase Travel Insurance
This form is designed with security measures in place to protect your information.
Your Name
*
First
Last
Departure Date of Trip/Travel
*
MM
/
DD
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YYYY
Destination of Trip & Reason for Travel
*
As an example ---
Iberostar Lindo, Rivera Maya, Mexico - Family Vacation
Princess Cruise, Eastern Caribbean - Honeymoon
Names of those traveling with you this form is to be used for:
Your E-mail
*
The address you wish to have receipts, replies and questions to be sent to.
Confirm E-mail
I have been informed of the cancellation policies for our travel services and have been made aware of the benefits of travel protection.
*** I have decided to:
*
I choose to purchase the Travel Insurance offered to me.
I decline the option to protect my investment. I choose not to purchase any of the Travel Insurance options offered to me.
I defer Travel Insurance at this time. I understand that if I fail to purchase insurance at a later date, my investment is not protected. I also understand that purchasing insurance later may mean some coverages and options may not be available.
Latitudes Travel offers a variety of different Travel Insurance options both through certain travel providers as well as a third party independent option.
Levels of protection and benefits differ by policy and, in some cases, may depend on when you purchase the insurance in regards to when you book your vacation/travel package.
Comments /Notes /
Special Requests
Authorization Confirmation
Enter Complete Name:
Last, First, Middle
*
By entering this information, you confirm the information on this form to be true and accurate.
Furthermore, I guarantee and warrant that I am Authorized to make this decision for all parties listed on this form.
Signature
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