info@APlusRTravel.com TRAVEL PURCHASE AUTHORIZATION For Non-Website Purchases

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Customer name:* This field is required.

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Date of birth:* This field is required.

Date

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Independent Travel Agent:

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Tel:* This field is required.

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Email:* This field is required.

example@example.com

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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.

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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.

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Billing Address:* This field is required.

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I authorize the charges associated with the following travel arrangements:

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Itinerary :* This field is required.

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Dates of Travel:* This field is required.

Date

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Booking Number: :

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Passenger Names :* This field is required.

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I have ACCEPTED and authorized the travel purchases above, including travel insurance, and I am aware the insurance premium is not refundable.

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Customer Signature:

Clear

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Date* This field is required.

Date

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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 (ST32452) , Washington (602-735-106) and California (2091941-40) as a seller of travel. © InteleTravel.com 2008 110108