Credit Card Information
Travel Protection Insurance
Travel Insurance: Medical, Cancellation and Interruption
We recommend travel insurance to protect against unforeseen illness, cancellation and travel interruption
__________ Accepted - I/We require travel insurance and not know of any reason that may cause me/us to cancel the planned travel

__________Declined - I/We do not require travel insurance and understand that cancellation and change penalties apply.

By signing this form, I/We agree to be bound thereby the following conditions: (Please initial the following):
________I/We fully understand and accept the Booking Terms and Conditions detailed to me prior to booking.
_______I/We have checked and verified the invoice and itinerary, including that the names are as per passports, and that flight details, dates and timings are correct.
______I/We are aware that valid passports, visas and health documents are required and that the obtaining of these documents is my/our responsibility if applicable.
______I/We agree and understand that Gala Travel Agency and/or their agents can accept no responsibility for loses or accidental expenses due to delays or changes in airline, cruise lines, hotels, resorts and rail or other means of transport schedule, hotel over-booking or default, sickness, weather, strikes, war, quarantine or other causes.
I am completing this form on behalf of the exclusive card holder, I have verified the cardholder's signature and I accept full responsibility for those charges should the cardholder decline these charges at a later date.
Gala Travel Agency
Ben Montgomery, Owner/President _____________________________
Credit Card Authorization
Credit Card

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CLIA and ARC #03524430