EmailMe Form - KARLENE'S CARIBBEAN TRAVEL BOOKING FORM

Number of Passengers *

Lead Passenger *

First Middle Last Suffix

Date of Birth *

MM / DD / YYYY

Gender (as indicated on passport)

Passport #

Passport Issue Date

MM / DD / YYYY

Known Traveler Number(PreCheck)

Passport Expiration Date

MM / DD / YYYY

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Seat Pref (when available)

Window

Aisle

Passenger 2

First Middle Last Suffix

Date of Birth

MM / DD / YYYY

Gender (as indicated on passport)

Passport #

Passport Issue Date

MM / DD / YYYY

Known Traveler Number(PreCheck)

Passport Expiration Date

MM / DD / YYYY

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Seat Pref (when available)

Window

Aisle

Passenger 3

First Middle Last Suffix

Date of Birth

MM / DD / YYYY

Gender (as indicated on passport)

Passport #

Passport Issue Date

MM / DD / YYYY

Known Traveler Number (PreCheck)

Passport Expiration Date

MM / DD / YYYY

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Air Seat (when available)

Window

Aisle

Passenger 4

First Middle Last Suffix

Date of Birth

MM / DD / YYYY

Gender

Passport #

Passport Issue Date

MM / DD / YYYY

Known Traveler Number (PreCheck)

Passport Expiration Date

MM / DD / YYYY

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Frequent Flyer

Frequent Flyer Name (ex. Delta)

Air Seat (when available)

Window

Aisle

Additional Travelers

Must include full legal name, date of birth and gender e.g. John Doe - 03/23/1993 - Male

Passenger Passports

Please upload a picture of EACH passenger's passport to our secure system.

TRAVEL PROTECTION

Karlene's Caribbean Travel recommends that you purchase travel insurance to protect yourself from any unforeseen events as most health insurance policies will not cover you in a foreign country. If you don’t think travel insurance is for you, please take a look at your passport. You’ll see the U.S. State Department recommends reviewing your health insurance before leaving the country because most policies (including Medicare) won’t cover you abroad. This means you will be responsible if you get sick or injured during your trip. If purchased you agree to all of the terms and conditions of the insurance program and you understand the coverage provided by the insurance company and will direct questions to the insurance provider.

Please ACCEPT or DECLINE travel protection. *

I would like to receive a quote for Travel Protection. I understand if I do not purchase within 21 days all pre-existing conditions will not be covered.

I choose not to protect my investment with trip insurance. I understand that the Karlene's Caribbean Travel will be held free of any claims made as part of this transaction.

I understand that by declining insurance, I cannot hold Karlene's Caribbean Travel responsible for any expenses incurred by me (or guests in my party) resulting from delay, cancellation of trip, accident, sickness, death, stolen or damaged luggage or property.

PAYMENT INFORMATION

Cardholder Name (as it appears on your billing statement)

First MI Last Suffix

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Billing Telephone *

### - ### - ####

Email - to receive payment confirmation *

Credit Card

Amount to be Charged

$ Dollars . Cents

I hereby authorize Karlene's Caribbean Travel and its representatives to charge my credit card as outlined above.

I understand that this form constitutes a legally binding contract and that by affixing my signature to this form, I will be held responsible for all agreed upon charges as well as any and all collection and legal fees.

This credit card is authorized for only the charges noted above. I agree that this payment information may be transmitted for charging directly to selected travel suppliers on my behalf by Karlene's Caribbean Travel that multiple transactions may be made; and that transactions are not to exceed the sum total of approved charges.

I am aware of any potential cancellation, refund and surcharge policies and fees by suppliers and agree not to dispute or chargeback any of the above signed for and acknowledged charges without proper course of action. A separate fee of $100 will be paid to Karlene's Caribbean Travel before cancellations will be made. A $30.00 amendment fee is a minimum tour change fee. If you request multiple changes and/or request the adjustments at the last minute, additional fees may apply (in addition to the $30.00 amendment fee). Paying the $30.00 amendment fee does not guarantee a change can or will be made.

Karlene's Caribbean Travel will not release personal information to any parties not listed on your finalized travel quote and will apply due diligence in maintaining records in a secured, safe location.

Signature *

Clear

Date

MM / DD / YYYY