Untitled Document

Barber Ball Reservation:

*Yes, I/we plan to attend. I would like : at $90.00 each = $asd
   
Please Complete with attendee's information:
*First Name:
*Last Name:
*Address:
* City:
* State:
* Zip / Postal Code:
(Ex: XXXXX or XXXXX-XXXX)
*Phone #:
(Ex: XXX-XXX-XXXX)
* E-mail:
 
Select One:
We do not have a seating preference, please seat us.
Please seat us at the table reserved in the name of
Corporate Sponsorship - Includes a table of ten, website promotion and recognition at the event
Gold Level - $5,000
Emerald Level - $2,500
Tickets are not issued. Please indicate how you would like to receive confirmation of your reservation and seating.
Email
Mail
 
If you are purchasing tickets for other guests at this time, please specify their names below separated by a comma.
 
Coupon Code:
 
In addition, I would like to make a tax-deductible contribution:
Founder's Gift $1000.00
Benefactor $500.00
Patron $300.00
Supporter $200.00
Friend $100.00
Other Amount   $
This information is the same as my billing information.

Credit Card Information:

Total Transaction Amount: $xx.xx
* Credit Card Holder Name:
Is this a company credit card?: Yes
No
If so, please list the company:
* Address:
* City:
* State:
* Zip / Postal Code:
(Ex: XXXXX or XXXXX-XXXX)
* Phone #:
(Ex: XXX-XXX-XXXX)
* E-mail:
* Card Type:
* Card Number:
No dashes or spaces.
* Expiration Date: /
* Security Code (CCV):
 

 

Click here for a printable Reservation/DonationForm