Tunica Academy - PTA
             
Saturday, March 23, 2019
6:00pm
Mid-South Ag Showroom
Tunica, Mississippi

$100 Ticket admits TWO for Cash Drawdown
$5,000 GRAND PRIZE
Dinner and Bar - Music and Dancing - Door Prizes
 
Payer's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
 
Student's NameLastname,Firstname
Students Grade
 
Admits TWO for Cash Drawdown:   $100.00   Quantity:   Item Subtotal:  
$0.00
If you are one of the last two finalist, would you [1]

If you are one of the last two finalist, would you

[2]

If you are one of the last two finalist, would you

[3]

If you are one of the last two finalist, would you

[4]

If you are one of the last two finalist, would you

[5]

If you are one of the last two finalist, would you

[6]

If you are one of the last two finalist, would you

[7]

If you are one of the last two finalist, would you

[8]

If you are one of the last two finalist, would you

[9]

If you are one of the last two finalist, would you

[10]
Second Chance Insurance:   $25.00   Quantity:   Item Subtotal:  
$0.00
Donation:   $   Item Subtotal:  
$0.00
Total:
$0.00
 
Payment Information
Method of Payment:
Processing Fees: Credit cards: 2.9% plus $0.30
eChecks: $0.55
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on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Payer's Information
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Billing ZIP/Postal Code:
 
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