EmailMe Form - BAPS Travel Trip Insurance Waiver Form

Now that you have arranged your trip, as professional travel agents we feel that it is our responsibility to recommend travel insurance to protect your investment. Please read the travel insurance quote we provided carefully in order to make an informed decision concerning this important matter. Ask us or call with any questions you may have.
Client Name *
First Middle Last
Client Contact Number *
### - ### - ####
Client Email Address *
Travel Departure Date *
MM / DD / YYYY
Travel Return Date *
MM / DD / YYYY
Travelers Names, DOB, and Ages Time of Travel *
Describe your vacation package inclusions:
Examples: All-Inclusive Resort, R/T Airfare, Rental Car, Hotel Stay, or Cruise for your group. (Some or all of these may apply)
Please read and then check to your indicate understanding of each of the following
(To be completed at the time of Initial Deposit and/or Payment): *
I/We have been ADIVISED of the cancellation penalties related to my purchase.
I UNDERSTAND that travel protection can protect me from possible loss of money due to a supplier filing bankruptcy/default.
I also UNDERSTAND that Travel Protection can cover accidents, sickness and/or death.
I further UNDERSTAND that Travel Protection can cover baggage loss, medical expenses, and emergency air transportation costs.
Travel Protection Option *
I ACCEPT Travel Protection Coverage
I DECLINE Travel Protection Coverage
I AM UNDECIDED (I understand that I MUST purchase WITHIN 7 DAYS of initial deposit to receive coverage AND I will be required to submit another travel protection form at the time my decision is made.)
Form Submitted By: *
First Last
Electronic Signature *
I declare that the above information is true and accurate. (Minimum of 2 Characters required)
Date Time *
MM / DD / YYYY HH : MM AM/PM
© 2016 KHM Consulting Inc. All Rights Reserved. KHM Travel Group® is a registered trademark of KHM Consulting Inc. California Seller of Travel Registration Number: 2089491-50. Registration as a seller of travel in California does not constitute the state's approval. Agent is not a participant in the Travel Consumer Restitution Fund. Florida Seller of Travel Reference Number ST37113. Iowa Seller of Travel Reference Number 960. Washington Seller of Travel Reference Number UBI 602 775 122. Cancellation and change penalties may apply to any travel arrangements booked. Details will be provided upon request.