Enroll within 7 Days of your Initial Trip Payment, Travel Guard Extra Benefits include:
* No Charge for all Children 16 and younger
!
* All Pre-Existing Medical Conditions !
* Change Your Mind Coverage - reimburses
you up to $250 if you cancel your trip simply because you change your mind
!
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Address
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State
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Home Phone
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Fax
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Date of Initial Trip Payment
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Return Date
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Rental Car
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Tour Operator/Cruise Line
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Additional Insureds
Insured
#2
Have you or Family Members received medical attention in the past 60 days?
Travel Agent
Trip Purchase Protection - Rates
For rates of trip costs over $5,000 or in excess of 30 days, please email
us Rates are subject to change.
Method of Payment
Discover/Novus
Name of Cardholder
Card Number
Expiration Date
If you choose to order by fax, complete the above, print it out and
fax it to 310-280-2861.
Travel Consultant
Please read before submitting
I represent that the above information is true and the dates are accurate.
The policy goes into effect at 12:01am on the day after the receipt, postmark,
telephone purchase or fax transmission date to Travel Secrets/Travel Guard.
We reserve the right to reject an application.
I understand that certain medical conditions are not covered. I have
read the Schedule
of Coverages and agree to its terms and conditions.
Confirmation of your policy, along with a certificate of insurance,
will be mailed to you within 7-10 business days, directly from Travel Guard.
If you have any questions please contact Travel Guard at 1-800-826-1300.
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All Rights Reserved.