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Precious Campbell

Precious Memories & Getaways

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		<field type="header" subtype="h2" label="𝑪𝑪 𝑨𝒖𝒕𝒉𝒐𝒓𝒊𝒛𝒂𝒕𝒊𝒐𝒏 𝑭𝒐𝒓𝒎"/>&#13;
		<field type="textarea" label="TRAVEL PURCHASE AUTHORIZATION" placeholder="For Non-Website (Inteletravel.com) Purchases: InteleTravel.com &amp;amp; Precious Memories &amp;amp; Getaways is pleased to confirm the following travel arrangements. To complete your transaction and confirm your arrangements  your signature on this authorization is required. This form is NOT required for electronic purchases you complete yourself on our website  www.InteleTravel.com,  preciouscampbell.inteletravel.com or its affiliates. Charges are payable ONLY to InteleTravel.com or the hotel  resort  tour operator  cruise line or other travel supplier.   If you have any questions  please be sure to reach out to Precious Memories &amp;amp; Getaways." name="travel-purchase-authorization" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="𝑵𝒂𝒎𝒆 𝒐𝒏 𝑪𝒂𝒓𝒅"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle Initial" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last Name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="𝑩𝒊𝒍𝒍𝒊𝒏𝒈 𝑨𝒅𝒅𝒓𝒆𝒔𝒔"/>&#13;
		<field type="text" required="true" label="Address Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Address Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Please check which applies:" name="checkbox-group-1774405320319">&#13;
			<option label="I have ACCEPTED and authorize the travel purchases below, including travel insurance, and I am aware the travel premium is non-refundable." value="i-have-accepted-and-authorize-the-travel-purchases-below-including-travel-insurance-and-i-am-aware-the-travel-premium-is-nonrefundable">I have ACCEPTED and authorize the travel purchases below, including travel insurance, and I am aware the travel premium is non-refundable.</option>&#13;
			<option label="I have ACCEPTED and authorize the travel purchases below, and I understand that by signing below, I am DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees  related to above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case of cancellation of non-refundable airline tickets or other arrangements,I agree to pay all applicable penalties according to the travel supplier's rules. " value="i-have-accepted-and-authorize-the-travel-purchases-below-and-i-understand-that-by-signing-below-i-am-declining-travel-insurance-i-have-read-and-understand-all-cancellation-charges-and-change-fees-related-to-above-travel-arrangements-and-that-i-may-not-be-entitled-to-a-full-refund-should-my-travel-plans-change-in-case-of-cancellation-of-nonrefundable-airline-tickets-or-other-arrangementsi-agree-to-pay-all-applicable-penalties-according-to-the-travel-suppliers-rules-">I have ACCEPTED and authorize the travel purchases below, and I understand that by signing below, I am DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees  related to above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case of cancellation of non-refundable airline tickets or other arrangements,I agree to pay all applicable penalties according to the travel supplier's rules. </option>&#13;
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		<field type="textarea" label="𝑻𝒓𝒂𝒗𝒆𝒍 𝑷𝒓𝒐𝒕𝒆𝒄𝒕𝒊𝒐𝒏 𝑪𝒐𝒏𝒇𝒊𝒓𝒎𝒂𝒕𝒊𝒐𝒏/𝑾𝒂𝒊𝒗𝒆𝒓" placeholder="For your protection  Travel Insurance is strongly recommended and available upon request from Inteletravel.com. You can enroll online for travel protection for Medical Expenses  Baggage Delays/Loss  Trip Delay or Cancellation  and other coverage  or your Inteletravel.com Independent Travel Advisor can arrange coverage for you. For an online insurance quote and purchase  go to www.Inteletravel.com and click on Insure It. To decline recommended travel insurance  your signature on this insurance waiver form is required. Final Travel Document (tickets  vouchers  etc.) cannot be sent to you prior to receipt of the signed insurance waiver." name="-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="I authorize Inteletravel.com, this supplier and/or Precious Memories &amp;amp; Getaways to charge for the authorized amount below." inline="true" name="i-authorize-inteletravelcom-this-supplier-andor-luxe-xscapes-llc-to-charge-for-the-authorized-amount-below" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
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By signing below, I authorize Precious Memories & Getaways to charge the credit card provided herein.

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