Travel Insurance Form

By law, I am required to offer you travel insurance. For this reason, I require that all of my clients complete, sign and submit this Travel Insurance Form indicating that you have been offered travel insurance, and should you choose not to purchase travel insurance you accept all responsibility.

Emergencies can happen when you least expect them. I 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. Another important fact to keep in mind is that most health insurance policies will not cover you when you are out of the country.

Your Travel Insurance will protect you in the following areas:

Trip Cancellation
Trip Delay
Trip Interruption
Missed Connection
Baggage Loss, Theft, or Damage
Baggage Delay
Emergency Medical and Dental Expenses
Emergency Medical Transportation
24/7 Hotline Assistance

Please also note that in order for you to benefit from pre-existing coverage your policy must be purchased before final payment. There is no added cost to the policy for pre-existing coverage.

It is also important to understand that you do NOT have coverage until you have an active policy! Pre-existing coverage will not apply to world events such as strikes, natural disasters, terrorism etc.

For your benefit, I have acquired a quote for travel insurance for your vacation. Your quote will be sent in a separate e-mail.

Please sign this acknowledgement to accept or decline the Travel Insurance that is being offered to you.* Please sign this acknowledgement to accept or decline the Travel Insurance that is being offered to you.* YES, I want to purchase Travel Insurance at this time. I will have coverage for pre-existing conditions. There are no added cost for this coverage. YES, but not at this time. Please understand that you are not covered until your policy has been purchased. NO, I do not want to purchase Travel Insurance, and assume all responsibility.

First Name

Last Name

Email Address

Contact Number

Street Address

City Address

State / Province

Postal / Zip Code

I have been advised of, and understand the benefits of Travel Protection Insurance. I understand that I do not have any coverage until 24 hours after this form has been signed and submitted. 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.

Departure Date

How did you hear about us? How did you hear about us? Blog Email Invite Search Engine: Google, Bing, Yahoo, etc. Mailer Social Media Word of Mouth / Direct Referral

Referrer

Address:	4380 South Syracuse St. Suite 310 Denver, CO 80237
Email:	info@teamais.net
Main Line:	(720) 221-8168
Toll-Free:	(877) 658-2472
Fax:	(720) 221-6787

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