Travel Insurance Request / Waiver Form

By law Q's Travel Service, LLC is required to offer you travel insurance. For this reason, we require that all clients complete, sign and submit our Travel Insurance (Request and Waiver) Form indicating that you have been offered travel insurance, and should you choose not to purchase travel insurance you accept all responsibility.

You are a valued client, and we want to do everything possible to make your trip enjoyable and worry free. Emergencies and unforseen issues can occur when you least expect it. We highly recommend that you protect your vacation with a travel insurance policy. The cruise lines, airlines, hotels and tour operators all charge high penalties for cancellation, ranging from the full deposit to no refund at all.

Without travel insurance, you’re on your own in a medical emergency because health policies will not cover you when you are outside of the United States. Most hospitals overseas will not accept your domestic health insurance card. They want your credit card instead because they expect payment up front before you receive care. When you have travel insurance, all you must do is call the travel insurance 24-hour assistance hotline. And finally, because loss bags, delayed and cancelled flights are common today than ever before -- TRAVEL INSURANCE PROVIDES PEACE OF MIND!!

Travel insurance forTrip Name* with a travel departure date of Departure Date returning onReturn Date

REQUEST / WAIVE TRAVEL INSURANCE COVERAGE: choose only one option*

I ACCEPT and authorize the travel purchases and request a travel insurance quote for purchase. Please select the insurance plan to receive your FREE quote (select all that apply):I DECLINE TRAVEL INSURANCE. I accept and authorize the travel purchases, 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 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 tickes or other arrangements, I agree to pay all applicable penalties according to the travel suppliers rules.

If you selected "I ACCEPT" from above and would like to receive a FREE quote, please select preferred plan type:

BASIC PLAN - The Basic Plan can prepare you for the unexpected with generous levels of protection for domestic and international travel. It's the ideal travel companion with features like trip cancellation protection, emergency medical benefits, 24-hour live assistance, and available benefit enhancements that can tailor the plan to fit specific needs. Plus, kids17 and under are covered for free when traveling with a parent or grandparent. Under certain conditions, covered reasons for some benefits of this plan include epidemic or pandemic-related illness, individually ordered quarantine, and denied boarding.CLASSIC WITH CANCEL AT ANYTIME - The Classic with Cancel Anytime Plan gives provides the extra flexibility of knowing you can cancel your trip for almost any unforeseen reason that the Classic plan does not already cover at 100% and receive 80% of their non-refundable trip costs back. It includes benefits like trip cancellation protection, primary emergency medical benefits, 24-hour travel assistance, and more. Please note: This plan must be purchased within 14 days of their initial trip deposit and must cover the full non-refundable trip cost ($10,000 maximum).Send Free Quote For Both Insurance Plans

Please list the name, and date of birth of each traveler to be covered by this insurance policy:

NOTE: Both plans provide SmartBenefitsSM that can pay you proactively and simplify the claims process with no receipts required. Under certain conditions, covered reasons for some benefits of this plan include epidemic or pandemic-related illness, individually ordered quarantine, and denied boarding.

I have been advised of, and understand the benefits of Travel Protection Insurance. Should I decline this protection, I understand that I will assume all financial responsibility for any expenses incurred as a result of being unable to travel, or travel disrupted for any reason as well as any medical expenses. I also understand that I must purchase Travel Insurance immediately to obtain maximum coverage, in order to be covered for any pre-existiing conditions travel insurance must be purchased prior to final payment has been made, and it must cover full cost of all non-refundable trip arrangements.

Full Name*

First NameMiddle NameLast NameSuffix

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Travel Insurance Form