Payment Form – Phoenix East Aviation: Forms

Student Name

First Last

Please enter the name as it appears on the Govt. Issued Photo ID (Passport / Driver's License)

Deposit Amount*

This is the final amount that will be deposited in the student's account.

Total

$0.00

Billing Details

Payer Email*

The payment receipt will be sent to this email address

Payer Phone Number

Card Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The billing address for the card being used.

Credit/Debit Card*

Cardholder Name

Card Details

Notes/Memo

Please enter any notes/message that you would like to pass along with this payment.

Consent*

I agree to the following policy:

I hereby authorize Phoenix East Aviation, LLC. to charge the aforementioned amount to the card entered above. I understand that this information will be used for purposes of verification with the credit card issuer/processor to prevent fraudulent usage. This procedure is executed within strict rules established in United States Code, Title 18, Part 1, Chapter 63.

Cardholder's Signature*

Please use your mouse/trackpad or your finger/stylus (on a touch device) to sign.

SPAM Prevention

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