Travel Booking Form
Thank you for choosing Travel by 83° West for your travel planning needs! If you are purchasing your travel arrangements(either partial or full payments or Customized Itinerary Fee) please complete the following credit card authorization form, as well as include all travelers details as this will be used on all your reservations (plane tickets, hotels, excursions, etc.) If you have any questions, please contact lweck@travel83west.com
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
*
-
Area Code
Phone Number
Emergency Phone Number
*
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Area Code
Phone Number
Email
*
example@example.com
Departure Date
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Month
-
Day
Year
Date
Return Date
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Month
-
Day
Year
Date
Home Airport
Do all travelers have a passport?
Yes
No
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
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First Name
Middle Name
Last Name
Birth Date
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Passenger #2
First Name
Middle Name
Last Name
Birth Date
Please select a month
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Passenger #3
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
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Month
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Passenger #4
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
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Passenger #5
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
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August
September
October
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December
Month
Please select a day
1
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Year
Passenger #6
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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Please select a year
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2022
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2020
2019
2018
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2015
2014
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COVID-19 WAIVER - I requested Travel by 83° West to make one or more travel bookings on my behalf. As the worldwide COVID-19 coronavirus pandemic remains ongoing at this time, I acknowledge that for this reason, and other reasons not reasonably foreseeable at this time, 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 insurance my vacation package may be non refundable and subject to change/cancel fees up to 100% without exception. This must be done at the time of booking. It cannot be purchased later.
*
Yes, I elect to purchase Travel Protection . Please charge my card per person for this
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 cardfor the amount listed below
Authorization Amount
Credit Card Billing Address:
*
Use credit card billing address above
Use credit card billing address below
Address
Street Address
Street Address Line 2
City
State / 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.
*
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 and cancellation policy here. http://www.travel83west.com/terms-and-conditions.html
*
Yes, I have read andagree with the supplier's terms and conditions and cancellation policy
Submit
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