Rural Security Fire Company

Fire & Ice Wine Fest 2008

TICKET PRE-ORDER FORM

Please print this form and return to:

Rural Security Fire Company
1301 N. Seventh Street
Lebanon, Pa 17046

Regular tickets (less that ten total)

  _____ Regular tickets @$18.00 each    Total amount:$________

_____ Non drinking tickets @ $10.00 each   Total amount: $________

Total for all tickets: $________

Group tickets (ten or more total)

_____ Regular tickets @$16.00 each    Total amount:$________

_____ Non drinking tickets @ $10.00 each   Total amount: $________

Total for all tickets: $________

Billing Information

Payment Method:  Cash/money order ____     Credit Card ____     Check ____

Please make checks and money orders payable to "Rural Security Fire Company"

All forms of payment please fill out information below:

Name:
_________________________________
Address:
_____________________________________________
_____________________________________________
Tel. No.
_____________________________________________
E-mail (opt.):
_____________________________________________

Credit card users fill out below:

Name as it appears on card:
______________________________________________
Billing address, if different:
______________________________________________
_______________________________________________

Card type:
____________________________________
Card Number:
____________________________________
Expiration Date:
____________________________________
Security Code (on rear of card):
____________________________________

For anyone ordering by credit card, your personal information will not be kept by this company after the card information has been run through our system.