Gravity Payments

Secure Payment Form- SSB Luncheon

Ticket & Sponsorship Summary:

Payment Date:

12/21/24

Payment Amount:

Credit Card Information:

Card Type:

Name as on Card:

Card Billing Address:

Card Billing Zipcode:

Card Number:

Card Expiration Date:

MMYY

Card ID (CVV2/CID) Number:
[What is the Card ID?]

Donor Information:

Company Name:

Name:

Address:

City:

State:

Zip:

Phone Number:

Email Address:

Tickets (Enter #) & Sponsorships (Enter Dollar Amount):

# of Tickets at $125 each:

$1,250 Champions Sponsor:

$2,500 Strong Sponsor:

$5,000 Smart Sponsor:

$7,500 Bold Sponsor:

$10,000 Bronze Sponsor:

$25,000 Silver Sponsor:

$50,000 Gold Sponsor:

$100,000 Best Friend Friend Forever Sponsor:

Unable to Attend But Donate: