MULTIPLE PAYMENT FORM

MULTIPLE PAYMENT FORM
This form is for making CREDIT/DEBIT card payments on your BIRD ACCOUNT. (you must have an account established to use this form) If this is YOUR FIRST TIME PURCHASE - see "No PayPal account?- "

NOTE:Please use full name & email address as it appears on our files.

* Required fields
Name *
E-mail Address *
PAYMENT AMT I WOULD LIKE TO MAKE TODAY. *
Please apply today's payment to the bird/s that I have reserved @ Oasis Aviary (Name the bird species) *
CREDIT/DEBIT CARD # *
EXPIRATION DATE *
(3) DIGIT CODE -on back of card *
	I authorize Oasis Aviary to charge my account today for the full payment amount above. IL residents will be charged IL Sales Tax. *

I have read and agree to the Privacy Policy *

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