I, the undersigned Booking Party, hereby request and authorize Utah Luxury Tours to cancel my entire tour booking referenced below:

 

 Tour Name/Name of Booking Party:
 Date of Reservation:
 Departure Date:
 Booking Number:
 Name of Credit Card Holder:
 Payment Method:
 Last four digits of Credit Card:
 Original Transaction Amount:

 

Brief Explanation of Reasons for Cancellation Request:

 

 

 

I also acknowledge that I have read, understand and agree to abide by the Cancellation Policy contained in the Terms as previously provided to me. All terms, including defined terms, contained in the Terms and Conditions of Service are incorporated herein by reference.

 

Requestor Signature

 

Date

 

Requestor Printed Name