Family Promise of COS
Hope, Hearts, and Home Luncheon

Secure Payment Form

Order Summary:
Date: 06/01/20
Individuals Attending ($65 each):
Tables (of 8) Reserved ($500 each):
Total Dollar Amount:
Your Name:
Your Phone Number:
Your Email Address:
Additional Names:
Number of Chicken Marsala:
Number of Beef Tips:
Number of Vegetable Wellington (Vegetarian):
Number of Gluten-Free Chicken Marsala:
Number of Gluten-Free Beef Tips:
Number of Gluten-Free Vegetable Wellington:
Please seat me with:
Congregation (if any):
Affiliation (Thrivent member, business, organization, etc.):
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Street Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:   [What is the Card ID?]