Travel Protection Waiver Form

Hazleton, Pennsylvania

info@beaamazedtravel.com

(570) 599-1754

Please complete all required fields and click submit

All information will be held confidential

Traveler Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Phone Number *

Names and Dates of Birth of Persons Traveling with You *

Certification

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 following bullets carefully in order to make an informed decision concerning this important matter. Please call or messge me with any questions you may have.

AT THE TIME OF FIRST PAYMENT:

◾I have been advised of the cancellation penalties for my purchase.

◾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.

◾I understand that I will be charged for any vendor cancellation fees and an additional agency fee of $50 per person in the event of cancellation if I do not purchase travel insurance.

At this time I wish to *

Purchase the recommended travel insurance

Decline the recommended travel insurance

Todays Date *

Signature *

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