EmailMe Form - Michelle's Insurance Form

Name *

First Middle Last Suffix

Date of Departure *

MM / DD / YYYY

PLEASE READ THIS CAREFULLY

Now that you have arranged your trip, as professional travel agents we feel that it is
ourresponsibility to recommend travel insurance to protect your investment.

AT THE TIME OF FIRST PAYMENT:

I have been advised of the cancellation penalties along with the terms and conditions of the supplier for my purchase. I acknowledge receipt of these documents.

I understand that Travel 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.

I understand that I must purchase Travel Insurance immediately to obtain maximum coverage.

I understand that the insurance premium is not refundable even when filing a claim.

At this time I choose: *

To purchase the recommended insurance

To decline the recommended insurance

Signature

Clear

Date Time

MM / DD / YYYY