Online Credit Card Purchases for

March 16th 2010

Luncheon Graphic
Ladies Luncheon
In Sarabeths Cafe in Lord & Taylor in
Garden City New York!

Full Name
Street Address
City
State
Zipcode
Phone
Email
Number of Tix at 55 pp
Group of 10 for 500 dollars
Would like a Signature Sponsor
Total to be charged
Type of Card
Account Number
Expiration Date
Names of all guests
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