EmailMeForm
EMBARK Travel Credit Card Authorization
& Trip Insurance Election Form
EMBARK Travel, Lisa Killeen - Owner
Name of Cardholder
*
First
Last
Email
Billing Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone Number associated
with this method of payment
*
###
-
###
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####
Is this address the same
as your home address?
*
Please select
Yes
No
Credit Card Information
Name as it appears on card:
*
First
Middle
Last
Card Type:
*
Visa
MasterCard
American Express
Discover
Credit Card
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
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Billing Zip Code:
*
Please Charge my cc listed above the following amount:
$
Dollars
.
Cents
Is this a Pre-Paid Credit Card?
*
Yes
No
If you chose YES, please make sure there is enough money loaded on the card to cover any transaction fee charged by the issuing pre-paid credit card company.
I authorize EMBARK Travel to use the card provided for my trip deposit that was agreed upon.
*
Yes
No
I also authorize EMBARK Travel to use the card provided for future payments on my trip. I understand, at any point, I can submit a new card for payments.
*
Yes
No
IF You are cruising, do you wish to Pre-Pay Gratuities by adding them to your cruise booking?
Please select
Not Applicable
Yes, Please add Pre-Paid Gratuities
No, I will pay on the ship
NOTE: If you do not add pre-paid gratuities, you will be charged gratuities to your OnBoard Account once on the ship.
By signing this form, I have authorized Lisa Killeen with EMBARK Travel to charge my credit card listed here for the travel & elected services for my upcoming trip. I have also been informed of the cancellation policies for our upcoming trip. I hereby authorize Lisa Killeen with EMBARK Travel to charge the indicated card listed for travel services as stated on this form. I guarantee & warrant that I am the legal cardholder for this credit card.
NOTE: IF YOU ARE USING A PRE-PAID CREDIT CARD, YOU MUST HAVE ENOUGH FUNDS LOADED ON CARD TO COVER CHARGE PLUS FEE CHARGED BY CREDIT CARD COMPANY.
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NOTE: PAYMENT FOR INSURANCE IS DUE AT TIME IT IS ADDED. IF YOU CHOOSE TO ADD IT AT THE BEGINNING, PLEASE KNOW YOU WILL BE PAYING THE DEPOSIT PLUS INSURANCE WHEN BOOKING A CRUISE.
Trip Insurance Protection
PLEASE READ CAREFULLY BEFORE MAKING YOUR CHOICE AND SIGNING.
Now that we have arranged your trip, as your personal travel advocate and a travel professional, it is my responsibility to recommend travel insurance to protect your investment.
Before going any further, ask yourself these questions:
1. Can you afford to miss your trip and lose your vacation investment, if something goes wrong due to illness, weather, or other unforeseen circumstances?
2. Can you afford to cover the cost of returning home if you are forced to end your trip abruptly?
3. Does your medical insurance cover you whenever and wherever you travel?
4. Would you know what to do in an emergency situation overseas?
5. Even if your medical insurance provides coverage while you are on your trip, can you afford to pay high deductibles or copayments imposed when you are outside the standard service area?
6. If your bags are lost or if you have to spend an extra night because of weather-related problems, can you afford to buy replacement necessities and pay for extra lodging?
By signing below, I agree that I have been advised of the cancellation penalties for my trip purchase. I acknowledge receipt of the Vacation Protection information.
I understand that Vacation Protection insurance can protect me from possible loss of money due to unexpected trip cancellation/interruption due to accident, illness, injury, and even more.
You never know when you might get injured or sick before or even during your trip. I especially recommend travel insurance for all international itineraries, as we never can be sure your US Health Insurance would be accepted in another country.
We certainly all hope there's no need for this coverage, but it's really great when you need it. So take a look and make a decision. It is usually no more than 10% of your entire trip cost. If it exceeds 10% and you have elected to purchase it, I will contact you with the amount before processing your purchase for travel insurance.
IF YOU OPT OUT OF INSURANCE,PLEASE NOTE IF YOU MUST CANCEL, YOU RUN THE RISK OF LOSING ALL OF THE MONEY YOU PAID ON YOUR TRIP.
NOTE: PAYMENT IS DUE AT TIME YOU ADD INSURANCE IN MOST CASES.
At this time, I choose:
*
Please select
Yes, add insurance now. I understand I must pay deposit plus cost of Insurance.
Yes, add insurance at final payment. I understand I will be paying final payment PLUS the cost of Insurance.
No, I'll risk my entire investment and decline insurance.
Insurance Waiver Signature
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Today's Date:
*
MM
/
DD
/
YYYY
