EmailMe Form - Travel Euphoria Travel Insurance Waiver

Your Name *

First Last

Date of Departure: *

MM / DD / YYYY

PLEASE READ THIS CAREFULLY!

Now that you have arranged your trip, as a professional travel agent I feel that it is my responsibility to recommend travel insurance to protect your investment. Please read the brochure that was emailed to you carefully in order to make an informed decision concerning this important matter. Ask or call me with any questions you may have.

AT THE TIME OF FIRST PAYMENT:

• I have been advised of the cancellation penalties for my purchase and have been provided with the Terms and Conditions from the Supplier/Vendor. I acknowledge receipt of the Travel Insurance brochure and Terms & Conditions from the Vendor/Supplier.

• 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 cost.

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

AT THIS TIME, I CHOOSE
(Check one) *

To Purchase the recommended Insurance, through one of the following: CSA, Travel Guard, Cruise Line Insurance or Tour group Insurance

To decline the recommended Insurance

Electrontic Signature: (Please type name) *

Prefix First Last Suffix

By signing the above form I agree to all terms and conditions.

By filling in your name above you have agreed to your electronic signature on this form, according to the Electronic Records and Signatures in Commerce Act.

Electronic Records and Signatures in Commerce Act website:

Date of signature *

MM / DD / YYYY