Authorization Form

Your Travel Specialist

Travel / Trip Cancellation Insurance:

Do you want Trip Cancellation Insurance?

Trip cancellation terms: Cancellation penalties could be up to 100% of the cost of my vacation. If I do not purchase insurance, I am responsible for any cancellation penalties.

My trip is a significant investment. Unique Romance Travel strongly recommends the purchase of travel insurance. If I choose to decline this valuable protection, I assume any financial loss associated with my travel arrangements. Unique Romance Travel is not liable or responsible for any expenses incurred as a result of cancellation & interruption, emergency medical/transportation, baggage & personal effects, flight & travel accident, and/or rental car physical damage.

Enter your initials to show that you have read and understand the statement above and that if insurance is not purchased, your travel agent is not liable or responsible for any expenses.

Passenger #1 Insurance Coverage
 
AcceptDecline
Passenger #2 Insurance Coverage
(if applicable)
AcceptDecline
Passenger #3 Insurance Coverage
(if applicable)
AcceptDecline
Passenger #4 Insurance Coverage
(if applicable)
AcceptDecline
Passenger #5 Insurance Coverage
(if applicable)
AcceptDecline

Passport Information:

Passenger #1 Passport:

Full Name
Date of Birth
Passport Expiration Date

Passenger #2 Passport:

Full Name
Date of Birth
Passport Expiration Date

Passenger #3 Passport:

Full Name
Date of Birth
Passport Expiration Date

Passenger #4 Passport:

Full Name
Date of Birth
Passport Expiration Date

Passenger #5 Passport:

Full Name
Date of Birth
Passport Expiration Date

Passport Terms & Conditions: We have given Unique Romance Travel our names as they appear on our passports and the expiration dates of our passports. Unique Romance Travel is not responsible for any denied boarding situations if the name is incorrect or the passport is expired. A passport is required for travel outside of the United States. If we do not have our passports yet, we will notify Unique Romance Travel of the correct information when we receive them. Passports must be valid for at least 6 months beyond your return trip for international travel. Some International Destination Require a Visa, please check to see if this is a requirement for your travel.

Enter your initials to show that you have read, understand and agree to the Passport Terms & Conditions

Your Information

Wedding/Trip Name
Your Name
Phone Number
Cell Phone Number
Email
Dates of Travel
Resort
Room Category
Room Request
Flight Request

Payment Information:

Credit Card Type
Name on Card
Credit Card Number
Expiration Date
CVV (3 or 4 Digit Code on back)

Billing Address:

Street Address
Street Address Line 2
City
State
Zip Code
I authorize Unique Romance Travel to charge my credit card for the amount of:

Signature: