subject_line
Payment Card Update
Member Name
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Name as it appears on card
*
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Credit Card Type
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Visa
MasterCard
American Express
Discover
Credit Card Number
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Expiration Date (mm/yy)
*
CVV Code
*
Would you like Orlando Aviators Flying Club to provide this card number to Atlantic Aviation for future fueling request? Note: This option may take few days to update with Atlantic.
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Yes
No
I authorize Orlando Aviators Flying Club, Inc. to automatically bill the card listed above for monthly club dues and aircraft rental use. Automatic billing may be canceled by providing written cancellation notice to Orlando Aviators Flying Club, Inc. Additionally, I authorize Orlando Aviators Flying Club, Inc to share this credit card information with Atlantic Aviation at the Orlando Executive Airport for fueling request.
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clear
I authorize Orlando Aviators Flying Club, Inc. to automatically bill the card listed above for monthly club dues and aircraft rental use. Automatic billing may be canceled by providing written cancellation notice to Orlando Aviators Flying Club, Inc.
*
clear
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