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10800 Biscayne Blvd., Suite 630, Miami, FL 33161
Phone:(305)981-9113 Fax: (305) 981-9397
Toll-Free: (800) 327-6709 E-mail: lnfo@maduro.com
www.MaduroDive.com Blog.MaduroDive.com
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TRAVEL AUTHORIZATION FORM AND TRAVEL INSURANCE OPTION

Both, the travel insurance option and credit card authorization below must be completed. All fields are mandatory
A check payment Is made payable to Maduro Travel and mailed to the address above.

You must either accept or decline the Travel Insurance below. It is automatically added to your invoice based on the cost of your trip. Coverage will not be in effect unless the premium is paid no later than the final trip payment date. Pre-existing medical condition exclusion is waived only if insurance is purchased within 7 days of initial deposit payment. If you do not want this valuable coverage, please decline below and we will automatically deduct if from your payment. Once paid, the cost of travel insurance is non-refundable after 14 days from payment.

We strongly recommend accepting travel protection.

Coverage includes: Pre-existing condition waiver (purchase insurance within 7 days of deposit) Trip cancellation and interruption reimbursement to tour cost with no deductible $500 Travel delay ($100 maximum per day) $75,000 Evacuation/Repatriation  $1,000 baggage/personal effects $25,000 emergency medical expense $25,000 accidental death and dismemberment 24-hour worldwide travel emergency and assistance services  Terrorist Acts within 30 days of departure date   A list of all coverages is detailed in the online insurance certificates provided.

Travel Insured International Customer Care: 1-866-684-0218 Product Number: T-13001

All fields are mandatory

Checking this box denotes you have received the certificate of insurance.

ACCEPT Travel Insurance Protection DECLINE Travel Insurance Protection
   
Type your Name to confirm: Date:
Country:

Note: The ip address 54.224.197.251 is also being recorded with your acceptance

 

CREDIT CARD AUTHORIZATION FOR TRIP INVOICE
CREDIT CARD CHARGE INFORMATION Reservation RV#
CARD NUMBER: EXPDATE:
NAME ON CARD:
CREDIT CARD TYPE: CVV: What is this?
     
     
  Type the text seen above here:  
     

CHECKING THE BOX TO THE LEFT DENOTES ACCEPTANCE OF OUR TERMS AND CONDITIONS.
Check this box to acknowledge you are the cardholder and you authorize us to charge your credit card for all amounts owed for deposit and/or final payment.