cash credit card check
Name: ________________________________________________
Please indicate your preferred form of payment below.
Address: ______________________________________________
CASH
City: ___________________ State: ______ Zip: ______________ Phone: _______________________________________________ Email: ________________________________________________
CREDIT CARD
*Single game(s) are $25 each or $100 for season pass
Season Pass All 6 games
August 29 vs Central Methodist Swenson Presentation
September 12 vs Avila University Winter-Spring Student Athlete Recognition
September 26 vs MidAmerica Nazarene Hall of Fame Day
October 17 vs William Penn Univ. 1990 Football Champ 25th Anniv. - ESPN3
*Please complete the form below
October 31 vs Graceland University Homecoming
CHECK Mail check to: Peru State College c/o Brenda Lutz PO Box 10 Peru, NE 68421
November 14 vs Benedictine College Senior Day
*Please make checks payable to Peru State College Credit/Debit Card Authorization Form *We do not accept American Express
Name on card: ________________________________________________________________________________ Billing address: ________________________________________________________________________________ Card #: ________________________________________________________ Exp. Date: ____________________ 3 Digit Security Code: _________________ Phone #: _______________________________________________ For more information or to reserve your spot today contact Brenda Lutz at 402.872.2350 or [email protected]
Please indicate your preferred form of payment below.
Address: ______________________________________________
CASH
City: ___________________ State: ______ Zip: ______________ Phone: _______________________________________________ Email: ________________________________________________
CREDIT CARD
*Single game(s) are $25 each or $100 for season pass
Season Pass All 6 games
August 29 vs Central Methodist Swenson Presentation
September 12 vs Avila University Winter-Spring Student Athlete Recognition
September 26 vs MidAmerica Nazarene Hall of Fame Day
October 17 vs William Penn Univ. 1990 Football Champ 25th Anniv. - ESPN3
*Please complete the form below
October 31 vs Graceland University Homecoming
CHECK Mail check to: Peru State College c/o Brenda Lutz PO Box 10 Peru, NE 68421
November 14 vs Benedictine College Senior Day
*Please make checks payable to Peru State College Credit/Debit Card Authorization Form *We do not accept American Express
Name on card: ________________________________________________________________________________ Billing address: ________________________________________________________________________________ Card #: ________________________________________________________ Exp. Date: ____________________ 3 Digit Security Code: _________________ Phone #: _______________________________________________ For more information or to reserve your spot today contact Brenda Lutz at 402.872.2350 or [email protected]
