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HOLY FAMILY CATHOLIC HOME EDUCATORS

Autumn Dance Cruise Secure Payment Form

* Multiple tickets must be for the same family, not guests. All attendees' must be members of approved groups.
Order Date
For HF Members - $35
For Non-HF Members - $40
Order Amount
Invoice Number
Customer IP
Description
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Name as on Check
Bank Routing Number
Bank Account Number
Social Security Number
Drivers License Number
Drivers License State
Company Name
First Name
Last Name
Address
Address 2
City
State
Zip
Country
Phone Number
Email Address
Attendee First Name(s)
Attendee(s) Last Name
Attendee Age(s)
To which group do you belong? (Must Select One)
Emergency Contact Name
Emergency Contact Home Phone
Emergency Contact Mobile Phone
Emergency Contact’s Relationship to Attendee