Total Amount Authorized Today

TRAVEL PURCHASE AUTHORIZATION For Non-Website Purchases.

To complete your transaction and confirm your arrangements, your signature on this authorization is REQUIRED. This form is NOT required for electronic purchases you complete yourself on our website, www.tpi.com, or its affiliates. Charges are payable ONLY to Travel Planners International or the hotel, resort, tour operator, cruise line or other travel supplier. Independent Travel Agents may not accept and process charges through any other account, or accept checks, cash or other forms of payment.

TRAVEL INSURANCE WAIVER For your protection, Travel Insurance is strongly recommended and available upon request from Chic International Travel. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. Elite Dream Travel can arrange coverage for you. For an insurance quote and purchase, please contact your travel agent. To decline recommended travel insurance, your signature on this insurance waiver form is required. Final travel documents (tickets, vouchers, etc.) cannot be sent to you prior to receipt of the signed insurance waiver.

Client First Name

Client Last Name

Address

City

State

ZIP Code

Phone Number

PLEASE CHECK WHICH APPLIES AND SIGN BELOW

I have ACCEPTED and AUTHORIZED the travel purchases below, including travel insurance, and I am aware the insurance premium is not refundable. I am aware that I will be responsible for filing and following up with my own insurance claims if necessary.

I have ACCEPTED and AUTHORIZED the travel purchases below, and I understand that by signing below, I am DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees related to the above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case of cancellation of nonrefundable airline tickets or other arrangements, I agree to pay all applicable penalties according to the travel supplier’s rules.

I agree on above selected statement.

Please select payment type

Pay in full the amount below

Pay deposit amount below and balance to be paid in full by due date

Pay deposit and then remainder amount in monthly installments on the 1st or the 15th of each month until balance is paid in full by due date.

If you chose the last option, please select which day of the month you would like your installment to be paid.

1st of the month

15th of the month

I hereby authorize Chic International Travel/ or the travel supplier that my booking is through to charge my credit card for travel reservation and confirm that the information for the credit card and billing address is complete and accurate.

Total Amount Authorized Today

By checking this field I give my consent to collect the above amount

Date

Name on Credit Card

Credit Card Number

CVC

Credit Card Expiration