Cardholder Authorization and Insurance Waiver
Please use this form to complete payments for trips with Destination Luxe Travel.

Roxanne Grewal
roxanne@destinationluxetravel.com
440-773-8327
  • $ .
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  • Enter numbers only, no spaces.
  • Enter 3 or 4 digit security code
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  • Please provide information regarding the trip to which this payment should be applied.

    Include final destination (or name of cruise ship) and traveler names covered under the reservation on which you are making this payment.
  • Important Liability Release Information

    Please review the following sections before accepting and signing below.
  • Release of Liability

    Destination Luxe Travel offers retail travel services to customers, which are provided by separate and independent vendors of travel services. Destination Luxe Travel does not operate, control, or otherwise provide the services of the independent travel vendors. Hence, by submitting this form, the customer agrees that Destination Luxe Travel acts only as agent for the client in acquiring transportation, hotel accommodations, sightseeing and other privileges, or services for the clients’ benefit, and on the express condition that Destination Luxe Travel shall not be responsible for any loss, accident, injury, delay, defect, omission or irregularity which may occur or be occasioned, whether by reason of any act, negligence or default of any company or person engaged in or responsible for carrying out any of the arrangements, or otherwise in connection therewith.
  • Please sign your name using your mouse or, if using a smart phone or tablet, with a digital pen or your finger.
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