Purchase a Plan

Travel Agent Location
Agent Information
Location Number (if applicable)
This number can be found on the back
of your brochure (e.g.: 33-7777)
Agent Code
Travel Agent
Are you a travel agent?
Please Select One*

   
Plan Options
 
TraveLite
 
Trip Cancellation
 

Trip Information
Departure Date*
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Return Date*
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Final Destination*
select
 
Tour Operator
select
 
Cruise Line
select
 
Originating Airline
select
 
Primary Traveler Information
 
First Name*  
Last Name*  
 
Date of Birth* (mm/dd/yyyy)
 /  / 
 
Trip Cost* (ex. 1000 or 1000.00)  
 
 

Address*
 
 
 
City*
 
State*
Zip*
  
Country*
select

Phone*
     
Fax 
     
Email
 
Beneficiary
(max 256 chars)
 
Additional Traveler Information
Traveler #2
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
 
 

Traveler #3
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
 
 

Add Travelers
Maximum limit of 10 immediate family members per policy.
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View Details

 
Select Flight Accident Level 
 



 
Rental Vehicle Protection
 
Policy Document Delivery Options
 
Delivery Method
 


 
Recipient #1
(Optional) Recipient #2

* Required Field
Plan Details
TraveLite
Benefit
Coverage

Trip Cancellation
100% of Trip Cost
Trip Interruption
150% of Trip Cost
Trip Delay
$750
Missed Connection
$750
Itinerary Change
$250
Baggage / Baggage Delay
$1,000 / $250
Medical Expense Benefits
$50,000
Medical Evacuation / Repatriation of Remains
$250,000
24 Hour AD&D
$25,000
Travel Assistance
Included
Policy Details
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For Assistance Please Call (800) 228-9792
The above information contains a brief description of benefits. Refer to the applicable Certificate of Insurance or Evidence of Coverage (the "Policy") for full policy details. Certain conditions, exclusions, and limitations apply as set out in the Policy. Products may not be available to residents of all states. If there is any conflict between the contents of this website and the Policy, the Policy will govern in all cases. *Assistance Services provided by Travelex's designated provider.