Initial Deposit Client Agreement Form

Hazleton, Pennsylvania
(570) 599-1754
Please complete all required fields and click submit
All information will be held confidential

Cardholder Information

Traveler Information

Please list all travelers names and birth dates as they appear on their official identificiation (i.e. passport and/or drivers license)

Passport Certification

I certify that everyone in my travel party (listed above in the traveler information box) has a valid passport or will have a valid passport at the time of travel. I also understand that most international destinations require that my passport is valid for an additional six months past the date of my arrival. Based on this information, everyone in my party is elidgible to travel internationally.
Please select one. *

Travel Insurance 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.



◾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: *

Payment Authorization

I hereby authorize Bea Amazed Travel to debit my credit card in the amount authorized above by me for the approved trip plans. I further certify that the information I have provided in the passport certification and travel insurance certification sections are true and correct. 
Signature *
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