Purchase Authorization

TRAVEL PURCHASE AUTHORIZATION

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.

TRAVEL INSURANCE WAIVER

For your protection, Travel Insurance is strongly recommended. I will provide a travel protection quote for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage.

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.

Independent Travel Advisor: Lynn Davenport PIN:P526353

Advisor Telephone: 970-302-5000

Email: Empoweredjourneytravel@gmail.com

Client Name

First NameLast Name

Email

example@example.com

Phone Number

TRAVEL PROTECTION. Please check ONE and sign below to accept or decline travel protection:*

I have ACCEPTED travel protection insurance, and I am aware the insurance premium is not refundable. (Insurance purchase has already been completed or will be completed through separate direct link to Allianz)I have DECLINED travel protection insurance but I have accepted and authorized the travel purchases below, and I have read and understand all cancellation charges and change fees related to these travel arrangements. I understand 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.

Signature

AUTHORIZATION for the following travel arrangements:

Last 4 digits only of credit card approved for this purchase (I will call you for credit card details)

Amount authorized $

I hereby authorize Inteletravel.com or the travel supplier that my booking is through to charge my credit card for this travel reservation and confirm that the information for the credit card and billing address is complete and accurate.

Name as listed on credit card

First NameLast Name

Billing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Today's Date

Date

Cardholder Signature

All rates subject to restrictions, availability and change. See www.InteleTravel.com for complete terms and conditions.InteleTravel.com is registered with the States of Florida (ST-32452), Washington (602-735-106), California (209-1941-40), Iowa (977), and Hawaii (TAR 6732) as a seller of travel. InteleTravel.com uses the personal data you disclose about yourself on this form only for the purpose of processing your requested travel purchase. We retain your personally identifiable data only as long as that processing requires. We do not share any of your personal data with any third party except for the purpose of completing your purchase, and then only with third-party travel providers and credit card processors who protect and only process your personal data for the limited purpose of this travel purchase. Following the completion of your travel that is the subject of this transaction, your personal information shall be securely destroyed unless InteleTravel.com is required by law to retain it, and then it will be retained only for that limited legally required purpose. For complete details regarding the protection of your personal information, please see InteleTravel.com’s Privacy Policy posted at www.inteletravel.com. © InteleTravel.com 2020