Credit Card / Insurance/Travel Waiver
Credit Card Waiver
For your protection as well as ours. We will need the following information to charge payment for your travel arrangements. It is understood that you have reviewed all reservation information and confirm that it is correct. This includes but is not limited to (traveler name(s), destination(s), airline, hotel, cruise line, dates, and times, etc...) You agree to the cancellation policy regarding your travel arrangements, and ALL terms and conditions. You understand that change fees, and cancellation penalities may apply and that you may not be entitled to a refund. As the credit card holder you understand that your signature waives your rights to credit card charge backs as a way to mediate a dispute pertaining to all travel arrangements made by this travel agency or one of our travel partners. You are advised that the posted charge on your billing statement may list as Simply Travel, LLC or one of our travel partners. You further awknowledge that NO travel arrangements will be confirmed on your behalf until our office has recieved this form.
Please charge the following amount to my credit card for my travel arrangements as agreed to by me verbally or in writing via email or text to Simply Travel, LLC.
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Name as it reads on your credit card and billing address.
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
Print your name as it reads on your Credit Card.
TRAVEL INSURANCE WAIVER
For your protection, we strongly recommend the purchase of travel insurance. Before confirming any policy. It is very important that you to understand the coverage and select a policy that is best suited for you. No representation or description of insurance made by Simply Travel, LLC constitutes a binding assurance or promise about travel insurance. Your signature represents your agreement to hold us harmless if you elect NOT to purchase travel insurance, or any denial of claim by the travel insurer as it relates to Covid-19, or ANY other claim under the policy. If you choose to purchase travel insurance the total premium will be added and paid for at the time of your trip deposit. Travel Insurance is non-refundable.
I choose to purchase travel insurance
I decline to purchase travel insurance
Print your name
TRAVEL RISK WAIVER
You acknowledge that it is your personal decision to travel. You fully understand that your travel arrangements may be interrupted or cancelled for reasons unforseeable at this time by the associated travel supplier, a government entity, or any other third party outside of this agencies control. You also awknowledge that travel involves the risk of a variety of hazards. From health to safety, including but not limited to natural disasters, injury, illness, disease, epidemics, and or pandemics. You agree that are traveling with full knowledge of any current travel warnings, recommendations, and restrictions that may be in place. Such as but not limited to Covid-19. Simply Travel, LLC assumes no responsiblity for and shall not be liable for unsafe conditions, or health hazards including epidemics and pandemics, or other illnesses. We have no special knowledge of dangers that may arise during travel. We highly recommend you review information regarding your travel destination(s) by visiting www.travel.state.gov before confirming any travel arrangements. For medical and health information we recommend you visit the Center for Disease Control website at www.cdc.gov/travel. Simply Travel, LLC has no responsbility for Covid-19 or any other requirements that governments, or travel suppliers may impose such as health affidavit forms, health screening prior to departure, or upon arrival, quarantines, or face coverings. For the latest on Covid-19 and other government travel regulations. We recommend visiting www.iatatravelcentre/international-travel-document-news.
Print your name
I (We) consent to Simply Travel, LLC collecting all personal information provided on this form. Including but not limited to name, address, phone number, email, and credit card information.