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Free Insurance Quote Request Form

Travelex Travel Plus Insurance

We represent the Travelex Travel Plus travel protection plan. This plan applies to either the independent traveler or to those taking tours or cruises. Use this fill-in form to provide some basic information about your trip so that we can help you*. You can also call us directly Monday - Friday 10AM to 4PM PDT at 1-800-434-6119.

Your Name (Required):

Your e-mail address (Required):
(Please double-check your email address. If it isn't correct, we can't get back in touch with you.)

Are you taking a cruise? or a tour? or neither?

If taking a cruise or tour: Name of Tour Company or Cruise Line

Total length of trip (in days)
(When calculating the length of your trip, don't forget to include departure and return days. )

Departure Date

Return Date

Please Note: All individuals being quoted together must be family members who purchase same coverage and travel dates.

Number of travelers:

Name of Traveler	Birth Date dd/mm/yy	Trip Cost

Do You want optional flight coverage?

Flight Accident Plan: $300,000 protection per person ($11.00 add'l)	Yes
or
Flight Accident Plan: $500,000 protection per person ($18.00/person, add'l)	Yes

Do You want Ad-On Rental Vehicle Damage Protection?
$5 x number of days up to 31: Number of days	Yes

In addition to your email quote would you like us to follow up with a phone call?
If so, please provide us with the phone number and best time to call you.
Phone Number/Best Time:

* This information is solely for the purpose of providing you with a quote. Information will not be used for any other purpose

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