checkout - Buy Flight Miles

MILEAGE ACCOUNT INFORMATION

MILEAGE account number

account holders NAME

Phone Number

email adress

I accept the terms and conditions

I hereby authorize Buy Flight Miles located at 147 Clinton Lane, Spring Valley, New York 10977 to charge my credit card for the amount indicated below. I understand these charges are for the payment of goods and/or services by the above referenced merchant.

Cardholder Name

*Please Input Card Holder Name

Credit Card INFORMATION

Type Of Credit Card

Credit Card Account Number Enter a valid 16 digit card number

*Please Input Credit Card Account Number

Expiration Date

*Please Input Expiration Date

CVV Code (digits on back of card)

*Please Input CVV Code

Charge Amount

Billing Address

*Please Input Billing Address

City

*Please Input City Name

State

*Please Input State Name

ZipCode

*Please Input ZipCode

Telephone Number

*Please Input Telephone Number

Please describe the goods and/or services received by the cardholder:

*Please Input Description

By signing below, I understand and acknowledge the charges described above. I also acknowledge payment in full is to be made when billed in accordance with the standard policy of the issuing bank. I hereby waive my right to dispute these charges.

Under the laws of the State of New York, I certify the foregoing is true and correct.

Cardholder signature

DATE

*Please Input Authorization Date