KaliKosmos Travel

Concierge Request Service

I, , agree to retain KaliKosmos Travel, independently contracted with Travel Leaders d/b/a Leone Travel Corp in Memphis, TN ("The Agency") to arrange concierge services of:



The Agency agrees to provide professional research and reservation services to me for the amount listed below. I acknowledge that The Agency will begin work on creating a specific request upon receipt of my payment in this amount. Accordingly, no portion of the fee is refundable. I understand that while my advisor will work to the best of her ability, some requests may not be possible in all locations.  I also acknowledge that the fee represents The Agency's charge for its planning services only; no portion of the fee represents the cost of the travel itself.

Concierge Request Service charges are applied when research on the requested item begins. A "single booking contact" is a single phone call or email in which one or more items can be confirmed at one time.

I will have an opportunity to review and approve the proposed reservation, as well as the associated pricing and the travel supplier terms and conditions before my advisor makes the reservations on my behalf, and on behalf of any other travelers for whom I have requested my advisor's assistance.

Changes made to the initial concierge request listed above may result in additional research fees.

All services quoted during the research are subject to availability and subject to change until the travel services have been secured with a payment.

Request Fee: $

Travel Leaders/KaliKosmos Travel Credit Card Authorization

If "no card on file" is listed below, a new card must be submitted.

Card Holder:  
Card Number On File:  **** **** ****
Expiration Date:

     Security Code:


 Card Holder:  
 Street Address:  
City:   State:   Zip:  
Phone:   Email:  


 Card Number:  
Exp:   Security Code:  



Total amount to charge: $  


By signing this form I authorize the above credit card to be on file for future payments and am aware that all payments carry with them restrictions and/or penalties once applied.

Sometimes charges will be made in international currency. Foreign purchase fees from credit card companies may apply.

Client assumes all risk and responsibilities associated with using debit cards for payments.


Leave this empty:

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Signed by Julie Grauf
Signed On: January 15, 2021

Signature Certificate
Document name: Concierge Request Service
lock iconUnique Document ID: 6b470f8d2aa81d3c74da49fccd4e1ebb802d88d7
Timestamp Audit
November 23, 2020 11:07 pm CSTConcierge Request Service Uploaded by Julie Grauf - julie@kalikosmos.com IP
November 23, 2020 11:18 pm CST Document owner forms@kalikosmos.com has handed over this document to julie@kalikosmos.com 2020-11-23 23:18:27 -