Family Promise of COS
Hope, Hearts, and Home Luncheon
Secure Payment Form
Order Summary:
Date:
07/02/25
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:
Visa
MasterCard
Discover
Name as on Card:
Card Billing Street Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date:
MMYY
Card ID (CVV2/CID) Number:
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