EmailMe Form - INSURANCE WAIVER

Name
First Last
Date of Departure
MM / DD / YYYY
Email
Phone
### - ### - ####
PLEASE READ
Now that you have arranged your trip, as a professional travel agent, it is my responsibility to recommend travel insurance to protect your investment. Please make sure that you have read the insurance policy information that was sent to you with your quote so you can make an informed decision about the purchase of the plan. Please do not hesitate to contact me if you have questions.
AT THE TIME OF FIRST PAYMENT
* I have been advised of the cancellation penalties for my purchase. I acknowledge receipt of information regarding vacation protection recommended for my travel plans.
* I understand that insurance con protect me from possible loss of money due to supplier bankruptcy/default, unexpected trip cancellation/interruption due to accident, sickness, death, baggage loss, medical expenses, weather related interruptions and emergency air transportation costs.
* I understand that I must purchase travel insurance immediately to obtain maximum coverage.
AT THIS TIME I CHOOSE (CHECK ONE)
To purchase the "Cash Back" option for insurance
To purchase the "Travel Credit" option for insurance
To decline the recommended insurance. I understand that my vacation may be fully NON REFUNDABLE if I do not purchase one of the offered policies
Signature
Clear
Date
MM / DD / YYYY