Ticket Order Form

Name  _______________________________

Address ______________________________

Phone________________________________

Mail this form to:

 Old South Christmas Ball

Post Office Box 211028

Augusta, Georgia 30917

 Tickets will be mailed to your address above.

Payment options

Check enclosed  _____

 Credit/Debit card:

     AMEX  _____            MC   _______             Visa _______

    DISCOVER _____      Visa  _______         Diners Club _____

Cardholder name

     Card # __________________________________                 Exp Date____________

 Signature __________________________________

Name on your statement will appear as .Martina.s Flowers & Gifts..

 (Make Checks  payable to Old South Christmas Ball)