Name: Alliance Aviation
Telephone: (786) 598-7978

Name*
First Last
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone*
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Email*
Gender
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Date of Birth
Date Format: MM slash DD slash YYYY
Place of Birth
Citizenship
Do you have a valid US visa?
- Yes
- No
If yes, please specify type of Visa
Visa Upload
Passport Upload*
All NON-US CITIZENS STUDENTS REQUIRING AN M1 VISA WHEN COMPLETING ANY FLIGHT TRAINING TOWARD A LICENSE, MUST PAY A CERTIFICATE FEE FOR I-20 OF $350
Highest Level of Flight Education Completed
Please provide the name, city and state of the high school you attended.
License Held*
License Upload*
File
3. Flight Hours Multi- Engine Turbo Jet Time (SIC, PIC):
Medical Upload
Medical Class/EXPIRATION DATE
Verification Letter from FAA Upload
***If you have a Foreign License and you are taking a Initial/ Type Rating or any course approved by FAA, please provide Verification Letter.
Cancelation
Notice of cancellation, must be received in writing at our office 45 days prior to class start date. Immediately, upon REFUND POLICY notification of cancellation Alliance Aviation will refund deposit. An amount of $200.00 will be used to cover administrative fees. Failure to cancel prior to 45 days from the start date will result in forfeit of entire deposit.
WIRE INSTRUCTIONS Chase Bank Account: Alliance Aviation, Inc. ABA routing: 267084131 Account number: 257883097 Swift: CHASUS33 Bank Address: 320 Crandon Blvd, Key Biscayne, FL 33149 Physical Address: 5600 NW 36 St. #615 Miami, FL 33116 ***Please reference customer name and/or payment information***
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BY SIGNING I CERTIFY THE INFORMATION ABOVE OF IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
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