Travel Information Disclosure Form

TRAVEL INFORMATION DISCLOSURE FORM

Provider Name:    Traveler Name:

RECITALS

WHEREAS, Provider is engaged in the business of arranging and coordinating travel-related services, including transportation, lodging, and ancillary services; and

WHEREAS, Traveler seeks to obtain travel arrangements and disclose certain personal, identification, itinerary and health information to Provider for the purpose of booking, coordinating, and administering travel services and related customer support; and

NOW, THEREFORE, in consideration of the mutual covenants herein, the parties agree as follows.

SCOPE OF SERVICES

Provider will perform travel coordination services limited to the items identified below and any ancillary actions reasonably necessary to arrange or amend reservations on behalf of Traveler. Services may include booking transportation, lodging, transfers, and procuring tickets for tours or events as requested in writing by Traveler.

TRAVELER INFORMATION

TRIP DETAILS

Destination:    Departure Date:    Return Date:

CONSENT TO DISCLOSE AND USE INFORMATION

Traveler authorizes Provider to collect, use, disclose and transmit Traveler's personal, identification, itinerary and health information as necessary to arrange travel services and communicate with third-party suppliers, including airlines, hotels, and ground operators. This authorization includes disclosure for booking, ticketing, emergency assistance, security screening, and regulatory compliance.

 I consent to disclosure of my information to travel suppliers and emergency contacts.
 I authorize Provider to make necessary booking changes and charge associated fees as described below.
 I consent to the limited disclosure of medical or mobility information to suppliers when required for safe travel arrangements.

PAYMENT TERMS

Traveler agrees to pay Provider the fees specified below for services provided under this disclosure. Provider may require deposits prior to procurement of reservations.

TERM AND TERMINATION

This Agreement commences on the date of Traveler's signature and continues until completion of the services described herein or until earlier terminated in accordance with this section.

Start Date:    End Date (if applicable):

Either party may terminate this Agreement for material breach by the other party if the breach remains uncured after the notice period specified above. Termination does not relieve Traveler of payment obligations for services already rendered or non-refundable supplier penalties incurred prior to termination.

CONFIDENTIALITY

Each party shall maintain all non-public information disclosed by the other party in strict confidence and shall not disclose such information except to employees, agents or third-party suppliers with a need to know for performance under this Agreement. Confidential information does not include information that is or becomes publicly available through no wrongful act of the receiving party, is already known by the receiving party without restriction, or is independently developed.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified below. Any dispute arising from this Agreement shall be subject to the exclusive jurisdiction of the courts located in that jurisdiction.

ENTIRE AGREEMENT

This document, together with any written confirmations or attachments executed by the parties, constitutes the entire agreement between Provider and Traveler with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, understandings and representations, whether oral or written. Any amendment must be in writing and signed by both parties.

ACKNOWLEDGMENT AND CERTIFICATION

By signing below, Traveler certifies that the information provided in this form is true and correct to the best of Traveler's knowledge, and acknowledges that certain supplier fees and penalties may be non-refundable. Traveler authorizes Provider to act on Traveler's behalf for the limited purposes described in this form.

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