Clearwater Cruises NEVER charges a Service Fee or Booking Fee

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Signature Form

Your Signature is REQUIREDA hard copy of this form is available by clicking here if you prefer to submit your agreement by regular mail (you may also right-click and "save taget as..." in order to save the file to your computer).
  • Fields marked with are required.
  • The invoice number is a 5 digit number found in the upper left portion of your Clearwater Cruises invoice.

Client Information -

* First Name: * Last Name:
* Invoice Number: * Email Address:

Travel Insurance Choice -

Select your insurance option below.

Your best option:

 Option 1: "I agreed to purchase Travel Insurance at or within 14 days of initial deposit . My travel protection begins immediately. By purchasing insurance within 14 days of deposit, and covering all nonrefundable trip costs I receive the added benefit of coverage for Existing Medical Conditions for myself, traveling partner, and immediate family members at no additional cost. I authorized my credit card to be charged for Allianz Travel Insurance.

Option 2: "I will purchase  Travel Insurance after final payment but no later than 48 hours prior to scheduled departure. My travel protection begins when the insurance is paid for but I will NOT have the benefit of waiver for Existing Medical Conditions. I authorized my credit card to be charged for Allianz Travel Insurance at time of final payment as listed on my invoice.
 Option 3: "No - I decline Allianz Travel Insurance coverage and accept the inherent risks and liabilities. The benefits have been explained, but by signing below I choose to decline Allianz Travel Insurance."

Emergency Contact -

In the event of an emergency we may need to contact a family member or friend for you. Please provide us with the name, address and phone number of the person you would like for us to contact on your behalf.
* (Emergency)Contact Name: * (Emergency)Relation to You:
* (Emergency)Address: (Emergency)Apt / Suite:
* (Emergency)Home Phone: (Emergency)Work Phone:
* (Emergency)City: * (Emergency)State:
* (Emergency)Zip:

Electronic Signature -

Paying by: Credit Card Check or Cash
By entering the following information and submitting this form I acknowledge that I have read and agree with the information on the Clearwater Cruises invoice #. I agree to pay those charges and I further agree to the terms and conditions provided with that invoice.
Final Payment –The charge will be processed to the same credit card when final payment is due.
* Last Four Digits of Card Number:
* Full Name as it Appears on Card: * Date: