EmailMe Form - TRAVEL INSURANCE: Intent to Purchase or Decline

TRAVEL INSURANCE: Intent to Purchase or Decline

Vacation Escapes by Jackie
Buen Viaje Travel
(612)524-8747
www.vacation-escapes.com
www.buenviajetravel.com

Travel insurance not only protects your vacation investment, but it also protect you, your party, and even your belongings. Vacation Escapes by Jackie/Buen Viaje Travel always recommends purchasing travel insurance, but acknowledges your right to decline this option. Before making your reservation, everyone traveling is required to complete this form (or have someone in their immediately family who is also traveling complete it on their behalf). This form acknowledges travelers have made the informed decision to purchase or deny travel insurance, and releases Vacation Escapes by Jackie/Buen Viaje Travel of any liability that may be related to this decision.

Legal Name: *
First Last
Today's Date: *
MM / DD / YYYY
Email: *

I am submitting this form on behalf of the following people in my IMMEDIATE FAMILY that are in my travel party, and confirm that I have the right to purchase or decline travel insurance on their behalf:

Traveler #1 (self)
Traveler #2
Traveler #3
Traveler #4
Traveler #5
Traveler #6
Traveler #7
Traveler #8
Traveler #9
Traveler #10
Traveler #11
Traveler #12
Traveler #13
Traveler #14
Traveler #15

Please list all individuals for whom you are declining travel insurance

I have read the information on travel insurance given to me by Vacation Escapes by Jackie/Buen Viaje Travel and understand that travel insurance will protect my investment. I also understand that in the case of trip cancellation the cost of the insurance is non-refundable. I/We have decided to: *
PURCHASE travel insurance (please provide me with more information to move forward with this purchase)
DECLINE travel insurance
I understand that I must purchase Travel Protection Insurance on the same day as my initial deposit in order to obtain maximum coverage. *
Please check box
I have been advised of the cancellation penalties for my purchase and I agree and understand that if I do not purchase Travel Protection Insurance and subsequently cancel my purchase, I may forfeit all money deposited at the time of cancellation. *
Please check box
I understand that Travel Protection Insurance can protect me from possible loss of money due to supplier bankruptcy /default, unexpected trip cancellation/interruption due to accident, sickness or death, baggage loss, medical expenses, and emergency air transportation costs. *
Please check box
By submitting this form I understand that I have released Vacation Escapes by Jackie/Buen Viaje Travel from any and all liability regarding the purchase or non-purchase of travel insurance. *
Please check box
Electronic Signature
Please type your full legal name

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