Pat Garrett Amphitheater Certificate Order Form
Print Order Form - Fill Out
Mail payment with a stamped, self-addressed #10 (business size) envelope to:
Pat Garrett Amphitheater Ticket Sales
P.O. Box 84, Strausstown, PA 19559 USA
or FAX 610-488-1576 (Credit Card Payment Only)
Shipped to:
Name on Card:___________________________________
Address:___________________________________
City:___________________________________
State/Providence:______________________Zip:_____________
Country:___________________________________
Date of Order ____/____/____
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| $25.00 Gift Certificate |
Qty. |
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Subtotal |
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| $50.00 Gift Certificate |
Qty. |
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Subtotal |
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| $75.00 Gift Certificate |
Qty. |
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Subtotal |
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| $100.00 Gift Certificate |
Qty. |
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Subtotal |
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| *Add $2.00 Non Refundable Credit Card Handling Charge For Each Certificate |
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| Order Total |
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No refunds or exchanges for any reason. Purchase of certificates implies acceptance of this policy.
Method of Payment
____Personal Check (2 weeks to clear) or Money Order enclosed (Payable to Pat Garrett)
____Credit Card*
(Select One) ____VISA ____ MC ____Disc
Card Number___________________________________
CID Number ________ (Located on the back of your card after the creditcard number)
Expiration Date ____/____/___
Signature (Required for Credit Card Orders)________________________________
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| Thanks for your order, Pat
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| Official Use Only | | Date Received | ___/___/___
| | Date Shipped | ___/___/___
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