Prepaid Visa® Card Order Form

Prepaid Visa® Card Order Form Lutheran Church Extension Fund (LCEF) is pleased to offer youth groups with an LCEF account the opportunity to purchase prepaid Visa cards. The cards can be used to cover meals and miscellaneous expenses while attending the 2016 National Youth Gathering in New Orleans. Facts you should know: • No PIN required for transactions; no purchase restrictions. • Cards cannot be used to obtain cash at ATM’s, LCEF Exchange or any financial institution. • Lost cards must be reported immediately; replacement cards may be purchased. • Remaining card value will be returned to the youth group’s account approximately 30 days after the close of the Gathering. • LCEF will issue a limited number of cards, which will be available on a first-come, first-served basis. Other important information: • Upon receipt of this request form, you will receive an email confirmation. • Visa cards will be available for pick-up at the LCEF Exchange at the Gathering:  Fri. July 15 1 p.m. until 5 p.m.  Sat. July 16 9 a.m. until 3 p.m. • The total amount due will be debited from your LCEF account on July 7, 2016.

Visa Card Value $150 x $200 x $250 x Total:

# of Cards

0

$ $ $ $

Amount Due 0.00 0.00 0.00 0.00

CONGREGATION NAME: _________________________________________________________________________ ADDRESS: EMAIL:

__________________________________________________________________________________

________________________________________LCEF ACCOUNT NUMBER: __________________________

AUTHORIZED SIGNER (please print) ___________________________________DAYTIME PHONE __________________ AUTHORIZED SIGNER SIGNATURE ___________________________________________________________________

Return form to LCEF by April 29, 2016! If you have any questions, contact an LCEF Information Representative at 800-843-5233.

Attn: NYG16 PO Box 229009 St. Louis, MO 63122-9009 or fax to: 314-885-6371 or 314-885-6378 S00363

Clear Form

201509

Print Form