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CREDIT AND DEBIT CARD AUTHORIZATION INFORMATION

NAME ON CREDIT  CARD: _____________________________
 
ACCOUNT #  XXXX XXXX XXXX
 _ _ _ _
(COMPLETE ONLY THE LAST FOUR DIGITS.  I'LL CALL TO GET THE OTHERS)


EXPIRATION DATE:_____/_____ 

CVV _ _ _ 

 

 BILLING ADDRESS:  _____________________________

CITY:___________________________________________


STATE: ________________  ZIP CODE: _______________

EMAIL ADDRESS:  ________________________________


 BILLING PHONE:  _________________________

SIGNATURE x______________________________________
 The above signature, if typed electronically,
is equivalent to a handwritten signature.

PASSENGER 1
NAME:

FEMALE __ MALE __

DOB:

FULL NAME: 
PASSPORT NUMBER: 
CITIZENSHIP:
DATE OF ISSUE: 
DATE OF EXPIRATION:
 
PLACE OF ISSUE: 
PLACE OF RESIDENCY:
PLACE OF BIRTH: 
ISSUING LOCATION:
 

EMERGENCY CONTACT OF PERSON NOT TRAVELING WITH YOU: 

NAME: 

RELATIONSHIP: 

ADDRESS:

PHONE: 


 

PASSENGER 2

NAME ON CREDIT  CARD _______________________________

 ACCOUNT #  XXXX XXXX XXXX _ _ _ _
(COMPLETE ONLY THE LAST FOUR DIGITS.  I'LL CALL TO GET THE OTHERS)

EXPIRATION DATE _____/_____ 

CVV

BILLING ADDRESS:

 

CITY:____________________________

STATE: _______  ZIP CODE: ________

BILLING PHONE:  _________________________

EMAIL ADDRESS:  ________________________________

SIGNATURE x______________________________________

The above signature, if typed electronically,

IS equivalent to a handwritten signature.
 

FULL NAME: 
PASSPORT NUMBER: 
CITIZENSHIP:
DATE OF ISSUE: 
DATE OF EXPIRATION:
 
PLACE OF ISSUE: 
PLACE OF RESIDENCY:
PLACE OF BIRTH: 
ISSUING LOCATION:
 

EMERGENCY CONTACT OF PERSON NOT TRAVELING WITH YOU: 

NAME: 

RELATIONSHIP: 

ADDRESS:

PHONE: 
 

IF CRUISING YOU MUST HAVE:
1. PASSPORT OR #2
2. BIRTH CERTIFICATE & VALID ISSUED GOVERNMENT ID OR DRIVER'S LICENSE.

OPTIONAL:
EMAIL COPIES OF YOUR PASSPORT (MUST BE VALID 6 MONTHS AFTER TRAVEL) AND YOUR BIRTH CERTIFICATE.  ALWAYS HAVE YOUR VALID GOVERNMENT ISSUED PHOTO ID WITH YOU. IF YOU DESIRE YOU CAN ALSO EMAIL A COPY OF YOUR ID.   THIS WAY, JUST IN CASE YOUR ITEMS ARE REQUESTED AND YOU DO NOT HAVE THEM IN YOUR 
POSSESSION, I CAN FAX OR EMAIL THEM TO THE NECESSARY LOCATION. AND HOPEFULLY, THEY WILL BE ACCEPTED.

 
FOR A CAR RENTAL WHO WILL THE DRIVER BE?

FULL NAME: _______________________

DOB:_______


PREGNANCY POLICY
http://www.aptatravel.com/3/miscellaneous20.htm

CUSTOMER SERVICE AIR FARE FEES:
DOMESTIC AIR PER PERSON : $25.00
INTERNATIONAL AIR PERSON: $50.00
GROUP RESERVATIONS PER PERSON: $10.00


AIR DISCLOSURE:

I, the travel agent, am not  an airline and I am not responsible for airline maintenance/safety problems; I do not operate aircraft and act only as an agent for identified airline principals that do. 

CUSTOMER SERVICE AIR FARE FEES WAIVED
IF IT'S A PACKAGE DEAL WITH HOTEL THERE IS NO FEE FOR AIR, INTERNATIONALLY OR DOMESTICALLY.
TRAVEL GUARD INSURANCE
https://travelguard.com

 
PLEASE, COMPARE THE PLANS AND LET ME KNOW WHICH ONE YOU DESIRE.  I'LL PREPARE THE QUOTE AND GET IT BACK TO YOU.  PAYMENT IS DUE LESS THAN 14 DAYS AFTER YOUR INITIAL TRAVEL DEPOSIT IS MADE. WE ARE NOT ALLOWED TO ADVISE YOU AS TO WHICH PLAN TO PURCHASE.  PLEASE COMPARE THE PLANS, SELECT THE ONE OF INTEREST, SEND YOUR FULL NAMES, DOBs AND ADDRESSES. WE WILL THEN SEND YOU A QUOTE TO REVIEW.  AFTER REVIEWING WE CAN PLACE THAT PURCHASE FOR YOU.  PLEASE SIGN BELOW LETTING US KNOW IF YOU ACCEPT OR DECLINE INSURANCE.    ALSO, CHECK OUT THE ANNUAL PLANS. Business Traveler & TRAVEL RITE ANNUAL PLAN.  

I, _____________________________, ACCEPT THE TRAVEL GUARD INSURANCE.

I, ______________________________, DECLINE THE TRAVEL GUARD INSURANCE.

 The above signature, if typed electronically,
is equivalent to a handwritten signature.


IF ACCEPTED NAMES AND DOBs OF ALL TRAVELERS.  ALL TRAVELLERS MUST LIVE IN THE SAME HOUSEHOLD.  YOUR NAMES AND DOBs CAN BE SENT BY EMAIL. 

PLEASE READ ABOUT THE OPTIONAL PLANS, THEN CALL ME WITH YOUR DECISION SO I CAN PREPARE YOUR QUOTE. 
 
https://www.travelguard.com/

Disclaimer FOR ALL ENTRIES ON MY TRAVEL SITE: 
I, Roberta K. Collins, agent with Aquarius Travel Agency, AKA (Always Plan Travel ASAP) reserves the right to correct any errors that may have occurred on this website.

CONTACT INFORMATION:
http://aptatravel.com
aptatravel@gmail.com
702.409.4088
 
TRAVEL GUARD