BV E&T_Customer Intake Form

***TRAVEL PURCHASE AUTHORIZATION For Non-Website Purchases***

Thank you for your purchase. InteleTravel.com is pleased to confirm the following travel arrangements. 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.InteleTravel.com, or its affiliates. Charges are payable ONLY to InteleTravel.com 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 InteleTravel.com. You can enroll online for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage, or your InteleTravel.com Independent Travel Agent can arrange coverage for you. For an online insurance quote and purchase, go to www.InteleTravel.com and click on Insure It. 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.

PLEASE SIGN ON THE LINE WHICH APPLIES

I have ACCEPTED and authorized the travel purchases above, including travelinsurance, and I am aware the insurance premium is not refundable.I have ACCEPTED and authorized the travel purchases above, 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,   First Name   Last Name , authorize InteleTravel.com and or this travel supplier: Butterfly Vizions Events and Travel (Belinda Brown), to charge my: (choose one)   AMERICAN EXPRESS   MASTERCARD   VISA   DISCOVER

For the amount of $      (USD) For the following travel arrangements: Itinerary:
Dates of Travel:        Date to     Date
Booking Number:

Passenger Names:

Signature

Customer Information Form

Air Travel

Cruise Vacation

Hotel and Resort Vacation

Car Rental

Package Tour

Other Information