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FOOTSTEPS WORLD TRAVEL Travel Insurance Waiver
Preparing Agent:
Susan Becks contact 330-242-1541
Stacy Quinn. contact 248-703-6854
Paul Becks. contact 330-242-7051
Destination of Travel (please enter a general description of destination)
Customer Name:
First
Middle
Last
Date of submission
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PLEASE READ THIS CAREFULLY Now that you have arranged your trip, as professional travel agents we feel it our responsibility to recommend travel insurance to protect your investment. Please read the provided Travel Insurance brochures carefully to make san informed decision concerning this important matter. If you have questions you may call us. AT THE TIME OF FIRST PAYMENT: I have been advised of there cancellation penalties for my purchase. I acknowledge receipt of Travel Insurance offerings. I acknowledge possible loss of monies due to Bankruptcy/ Default of the provider, medical expenses, and emergency medical transportation costs. I understand that I must purchase Travel Insurance immediately in order to obtain maximum coverage. AT THIS TIME, I CHOOSE (check one)
Choose one selection
To purchase recommended Insurance
To decline the recommended insurance
To reconsider my options
Signature
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