Name:*
E-mail:*
Phone:
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Reservation Number (may leave it blank if you do not have one):
Name of your Guru Travel Professional: *
Amount to Charge:
Select Payment Method:
Credit Card Number:
Expiration Date:
Security Code (found on back):
Address:*
I acknowledge that I have been offered travel insurance by my Guru Travel, LLC agent. *
Guru Travel recommends the purchase of travel insurance. I hereby verify that I have reviewed my travel itinerary for accuracy. I have been advised of all fees imposed by suppliers, and I have been offered the option of purchasing travel insurance. I understand that any changes to my reservation may result in additional cost and/or penalties. Please indicate what you have decided below: *:*
Please type in your name as your electronic signature to verify the information above. Must include both first and last name or the charges will not be accepted by Guru Travel, LLC. *
Notes for your agent: