Priority Club Rewards Gift Point Request Form
Fax Completed form to: 1-800-725-8232
Or
Contact your nearest Priority Club Rewards Service Center to complete your Transaction
Priority Club Member who is purchasing the Gift Points:
Name (Print):
Priority Club Member Number:
Priority Club PIN:
Priority Club Member who will be receiving the Gift Points:
Name (Print):
Priority Club Member Number:
Number of Priority Club points requested to purchase:
Note:
1,000 point minimum purchase quantity
1,000 point required increment purchase quantity
40,000 point maximum purchase limit per rolling 12 month period
Point purchase volume discounts apply to individual orders.
Cost:
Total
Number of
Point Price
Total Cost
Purchase
Points to Purchase
1,000-9,000 points
X $0.0135
=
10,000-19,000 points
X $0.0125
=
20,000-40,000 points
X $0.0115
=
Credit Card Payment Type:
AMEX
VISA
MC
Discover
Diner’s Club
Name on Credit Card (Print)*:
Credit Card Number: Expiration Date:
Authorization Signature (Required)*:
(or e-mail address for electronic submission)
Date:
Phone Number: ( )
*Must be the same person
BY SUBMITTING THIS ORDER FORM YOU (1) AUTHORIZE PRIORITY CLUB REWARDS AND/OR ITS AGENT TO CHARGE THE
PURCHASE TO YOUR CREDIT CARD ACCOUNT AS INDICATED ABOVE AND (2) ACKNOWLEDGE THAT YOU HAVE READ THE
PRIORITY CLUB TERMS & CONDITIONS AT WWW.PRIORITYCLUB.COM, “PRIORITYCLUB TERMS AND CONDITIONS”, AND YOU
WILL ACCEPT AND WILL BE BOUND BY THE TERMS THEREOF. NOTE THAT THIS IS A NON-REFUNDABLE TRANSACTION.