Family Promise of COS

Family Promise of COS
Hope, Hearts, and Home Luncheon
Secure Payment Form

Order Summary:

Date:

01/25/20

Individuals Attending ($50 each):

Tables (of 8) Reserved ($400 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: