SEASON TICKETS 2005/2006
CONTACT DETAILS
Title: Mr……..Miss……..Mrs……..Ms……..
First Name: ……………………………………………………….
Last Name: ……………………………………………………….
Address: ……………………………………………………….
: ……………………………………………………….
: ……………………………………………………….
Postcode: ……………………………………………………….
Email
Address: ……………………………………………………….
Phone (day): ……………………………………………………….
Phone (work): ……………………………………………………….
SEASON TICKET DETAILS
No. of Adult Tickets:
…….. @ £150 (£130): …………
No. of Child/Student/OAP Tickets: …….. @ £100 (£90):
…………
Total
Order Value (£): …………
PAYMENT DETAILS
I
am paying by: Cheque …… Credit/Debit Card
……
Cheque
(in full): (payable to “London
Basketball Ltd.”)
Card
Type: (Visa, MasterCard, Switch,
etc)……………………
Valid From: ……./…….
Expiry: ……./…….
Card Number: ………………………………………………………
Issue Number: ………………………………………………………
Name on Card: ………………………………………………………
REFERENCE (for office use only)
Date: ………… Taken By: ………….
Verification Code: ………… Prepared By: ………….