Credit Card Authorization Form

Form completed by:

Lead passenger name:

Billing Address:


Please complete below to indicate if you wish to purchase the insurance that was recommended to you.

I have been advised by Downunder Travel agent that the following travel insurance discussed is available and understand that by opting out of insuranceany expenses incurred, while not covered by a travel insurance policy, will be of my own financial responsibility. My travel agent/agency has no responsibility for these possible expenses.

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