Travel Notification

MEMBERS: Please complete the following form to notify Revity of debit and/or credit card usage while traveling outside of the United States.

  • OK Member Name is required
  • OK Phone is required
  • OK Revity Account Number is required
  • OK Last 7 digits of DEBIT CARD is required
  • Optional OK Last 6 digits of CREDIT CARD is required

  • Travel Departure Date

    OK Travel Departure Date is required

  • Travel Return Date

    OK Travel Return Date is required
  • Optional OK Comments is required
  • OK Security Code is required
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