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 purchasing your travel arrangements please complete the following credit card authorization form, as well as include all travelers details as this will be used on all your reservations (airfare, hotels, excursions, etc.) Credit card numbers will be taken by phone. If you have any questions, please contact lweck@travel83west.com
Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone*
Emergency Contact Phone*
Enter Email*
Confirm Email*
Time Zone*
Departure Date*

MonthDayYear
Date
Return Date*

MonthDayYear
Date
Home Airport*
TRAVELER DETAILS

Full names must be listed as they appear on your government-issued identification and passport for ALL travelers. If additional space is needed please email a photocopy/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 WAIVER - I requested Travel by 83° West to make one or more travel bookings on my behalf. I acknowledge that events unforeseeable at this time, such as a world wide pandemic like COVID-19, these travel plans may be interrupted or cancelled by the supplier that is providing them, a government entity or other third party over which Travel by 83° West has no control. I further acknowledge that the supplier’s own cancellation, rebooking and refund policies, subject to any applicable law that is now or may later be in effect, will govern my rights and remedies, including my right to receive a refund, in such an event. Moreover, I understand that should I elect to purchase travel insurance, the terms of the policy will dictate whether, and to what extent, coverage for any financial loss may exist under the circumstances. By signing below, I hereby agree to hold Travel by 83° West and release it from any and all liability for any damages, including but not limited to monetary losses I may incur as a result of such interruption or cancellation of these travel plans.*

Yes, I agree.
TRAVEL PROTECTION - I have been advised of the option to purchase travel insurance. I understand that if I decline to purchase travel protection, I am solely responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own separate travel, medical and any other provisions in the event of an emergency while I am traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier or any travel-related operator defaults. This waiver confirms that I voluntarily accept or decline travel insurance and travel protection insurance for the trip described above. I understand I am solely liable for all airline fees, supplier fees and agency fees that may apply, and I hereby release Travel by 83° West and its agents from any and all liability related to the trip described above.*

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, less any applicable discount(s).Please charge my card for the amount listed below
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 complete the authorization to charge your credit card, you must sign your name in the field below. This will serve as your electronic signature - the equivalent to signing your name on a printed credit card authorization slip.

Clear
Agreement- I understand my reservations will not be processed until this completed authorization is received and if not received within all applicable deadlines, my booking may be automatically cancelled. View Payment/Cancellation Policy and Terms and Conditions - http://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.
Should be Empty:

Travel Booking Form