Credit Card Authorization - Travel by 83* West

Travel Booking Form

Thank you for choosing Travel by 83° West for your travel planning needs! If you are moving forward with your travel arrangements, please complete the credit card authorization form and provide full details for all travelers. This information will be used to book all components of your trip, including airfare, accommodations, excursions, and more.Please note: Credit card numbers will be collected by phone for security purposes.If you have any questions, feel free to contact lweck@travel83west.com
Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone*
Enter Email*
Confirm Email*
Departure Date*

MonthDayYear
Date
Return Date*

MonthDayYear
Date
TRAVELER DETAILS

Please provide the full legal names of all travelers exactly as they appear on your government-issued ID and passport. If additional space is needed, you may email a photocopy or image of your passport to lweck@travel83west.com.
Passenger #1*

First NameMiddle NameLast Name
Date of Birth*
Passenger #2

First NameMiddle NameLast Name
Date of Birth
Passenger #3

First NameMiddle NameLast Name
Date of Birth
Passenger #4

First NameMiddle NameLast Name
Date of Birth
Passenger #5

First NameMiddle NameLast Name
Date of Birth
Passenger #6

First NameMiddle NameLast Name
Date of Birth
TRAVEL ACKNOWLEDGEMENT & LIABILITY RELEASE: I have requested that Travel by 83° West make one or more travel bookings on my behalf. I understand that unforeseen events—such as a global pandemic (e.g., COVID-19)—may disrupt or cancel these travel plans due to actions taken by travel suppliers, government agencies, or other third parties beyond the control of Travel by 83° West.I acknowledge that in such cases, the supplier’s own cancellation, rebooking, and refund policies—subject to applicable laws now in place or enacted in the future—will determine my rights and remedies, including any eligibility for refunds.If I choose to purchase travel insurance, I understand that coverage for financial loss will depend on the specific terms and conditions of the policy.By signing below, I agree to release Travel by 83° West and its agents from any and all liability for damages or losses, including financial losses, that may result from the interruption or cancellation of my travel plans.*

Yes, I agree.
TRAVEL PROTECTION WAIVER: I acknowledge that I have been offered the option to purchase travel insurance. If I decline this coverage, I understand that I am solely responsible for any cancellation penalties, out-of-pocket expenses, and emergency costs incurred during my trip. I also understand that I will not be protected in the event of a travel vendor, supplier, or operator default.This waiver confirms that I am voluntarily choosing to accept or decline travel insurance for the trip described above. I accept full responsibility for all applicable airline, supplier, and agency fees, and I hereby release Travel by 83° West and its agents from any and all liability related to this trip.*

Yes, I elect to purchase Travel Protection.No, I do not elect to purchase Travel Protection.
Payment Amount*

Please charge my card for the deposit required per person to secure this booking.Please charge my card for the full/final payment of my booking.
Authorization Amount
Credit Card Billing Address**

Use credit card billing address aboveUse credit card billing address below:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
To authorize the charge to your credit card, please sign your name in the field below. This will serve as your electronic signature and is the legal equivalent of signing a printed credit card authorization form.

Clear
Agreement: I acknowledge and agree to the Payment and Cancellation Policy and Terms and Conditions of Travel by 83° West, which can be reviewed at: www.travel83west.com/terms-and-conditions.html*

Yes, I have read and agree with Travel by 83 Degrees West terms and conditions and cancellation policy.
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Travel Booking Form