Who is your Travel Agent?
Your Confirmation Number:
Please use your confirmation number found on your invoice.
Is this a Honeymoon Registry Gift?
If so, please provide the couple's name(s):
Credit Card Type
Credit Card Type
Other OR Final Payment
Honeymoon Registry Gift
Additional Comments :
My travel party has reviewed the dates, times, payment due dates, and cancellation policy for reservations made on our behalf by LBAC Inc. and we agree that they are correct and accurate. Notice: Passenger(s) are required to carry proper identification when traveling. You as the traveler are responsible for understanding & obtaining the proper travel documents in advance of your travel commencement. LBAC Inc. acts as a sales agent for any airline, hotel, car-rental company, tour operator, cruise line, or other service provider named in your itinerary (“Suppliers”). LBAC Inc. is not responsible for acts or omissions of the Suppliers or their failure to provide services or adhere to their own schedules. LBAC Inc. assumes no responsibility for and shall not be liable for any refund, personal injury, property damage, or other loss, accident, delay, inconvenience, or irregularity which may be caused by: (1) any defaults, wrongful or negligent acts, or omissions of the Suppliers; (2) any defect in or failure of any vehicle, craft, equipment, or instrumentality owned, operated, or otherwise used or provided by the Suppliers; or (3) any wrongful or negligent acts or omissions on the part of any other party not under the LBAC Inc’s control. You hereby release LBAC Inc. from all claims arising out of any problem covered in this paragraph. LBAC Inc. has no special knowledge regarding the financial condition of the Suppliers, unsafe conditions, health hazards, weather hazards, or climate extremes at locations to which you may travel. For information concerning possible dangers at destinations, LBAC Inc. recommends contacting the Travel Warnings Section of the U.S. State Department at (202) 647-5225 or www.travel.state.gov
. For medical information, LBAC Inc. recommends contacting the Centers for Disease Control at (877) FYI-TRIP or www.cdc.gov/travel
. You assume full and complete responsibility for checking and verifying any and all passport, visa, vaccination, or other entry requirements of your destination(s), and all conditions regarding health, safety, security, political stability, and labor or civil unrest at such destination(s). You hereby release LBAC Inc. from all claims arising out of any problem covered in this statement. I agree to indemnify, defend and hold harmless LBAC, Inc, its officers, independent contractors, affiliates, employees and representatives from and against any and all costs, expenses, damages, lawsuits, and or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss or death from or related to the COVID - 19 pandemic. By submitting, you certify that you are the cardholder and are authorizing the travel agency or its chosen Tour Operator/Supplier/Cruise Line to charge the listed amount to the credit card. You certify that you have verified that all information contained in the confirmation you received is accurate. You also certify you have read the Terms & Conditions and the appropriate Travel Protection Plan details. Cancellation penalties may apply. Insurance is not refundable. This charge will be manually applied by the agency to your reservation. If there are any issues, an agent will get back to you. Please note that you may not see a charge from the travel agency on your credit card statement; the charge will come from our supplier and/or the airline directly. Payment may take 3-5 business days to fully process and be reflected on your statement.
By checking the box below and adding your signature, you indicate that the above amount is correct, you authorize the travel agency to charge your credit card for the specified amount, and you agree to the terms and conditions.
Electronic Signature: (Sign with mouse or touch)