Frequent Flier Miles Redemption Request.

Salutation: Mr. Ms.  Mrs. Dr.  
First name:
Last name:
Middle name:
Home phone:
Work phone:
E-mail:
Address, line 1
Address, line 2
City:
State:
Zip/Postal Code:

Airline you made your reservations on:

Reservation number:

Number of miles you wish to redeem: use the table on the previous page

Total cost of reservations, including taxes: remember, this cannot exceed the total value of your award

Number of seats Names of passengers

Leaving from city and airport (example: New York JFK) Going to

Departure date (mm/dd/yy)

Returning on (mm/dd/yy)

Copyright © 2008 Avviva, Inc. All rights reserved.