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Insurance Email Worksheet
Insurance Email Worksheet
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Insurance Email Worksheet
Please complete the following information for your insurance purchase. If there are any changes or cancellations please make sure to submit a new worksheet. All forms should be completed PRIOR to your client's travel dates.
Primary Agent Name
*
Agent ID
*
Date Submitted
Type of Booking
Individual Booking
Group Booking
*
Purchase Date
*
Insurance Company Name
*
Plan/Confirmation Number
*
Policy Number
*
Policy Amount
*
Commission Amount
First Passenger Name
*
Second Passenger Name
Third Passenger Name
Fourth Passenger Name
Passenger Name to Contact
Home Telephone
Business Telephone
Email Address
FAX
Cruise/Tour Company
*
Date of Departure
*
Date of Return
*
Form of Payment
Check
Money Order
Credit Card
Notes/Comments
To receive a copy of this worksheet enter your email address here.
*
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