Coverage and Agency Information: Policy Number: Today's Date: Person Requesting Change: Insured's Name: Insured's Phone: For your convenience, coverage changes are now available online within 15 business days of submission Monday through Friday. Click here to print your current travel insurance documents. No further confirmation of the change will be sent to you. Thank you for choosing Travel Guard! Contact Email: Please select appropriate box to indicate one or more of the following options and enter your information in the fields provided. Change in Travel Dates Original Dates (MM/DD/YYYY): to New Dates (MM/DD/YYYY): to A claim cannot be filed regarding any issue that involves the previous travel dates. No change can be made to coverage after the original return date. Trips over 30 days are subject to an additional per day premium. Addition of Airline/Tour Operator/Cruise Line Departing Airlines: Tour Operator: Cruise Lines: If this addition increases the trip cost, please remember to increase policy coverage in the section below. Increase/Decrease in Trip Cost Primary Insured Original Trip Cost: $ Primary Insured New Trip Cost: $ Additional Insured Original Trip Cost: $ Additional Insured New Trip Cost: $ Credit Card Type: -- American Express Diners Club Discover Master Card Visa Corporate Card Credit Card Holder: Credit Card Number: Expiration Date (MM/YYYY): -- 01 02 03 04 05 06 07 08 09 10 11 12 / -- 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Password: If customer wishes to pay by check, form should be printed and mailed with payment. Coverage cannot be increased until correct premium is received. Requests for decreases in trip cost will not be processed. Any additional information such as other insured's names please add in the additional comments section below. Apply New Payment Reason for Payment: -- Saved Quote Declined Credit Card Credit Card Type: -- American Express Diners Club Discover Master Card Visa Corporate Card Credit Card Holder: Credit Card Number: Expiration Date (MM/YYYY): -- 01 02 03 04 05 06 07 08 09 10 11 12 / -- 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Password: Change of Destination Original Destination: New Destination: Please include city and state for destinations within the USA and country for international destinations. Spelling Correction of Insured's Name Primary Insured: How name currently appears Primary Insured: Correct spelling of the name Additional Insured: How name currently appears Additional Insured: Correct spelling of the name Coverage is non-transferable. Correction of Mailing Address How address currently appears: Correct address: Add Beneficiaries Names of the Beneficiaries to be added: All the beneficiaries will be given equal percentage of the benefit. Additional Comments Do not enter any credit card data in the text box below. Policy Refund Requests must be submitted to Travel Guard in writing, within 15 days of the effective date of the policy, provided it is not past the original departure date. Please click here to submit the request.