On-Line Ticket Order
(* Required Fields)
You may register up to 2 guests at a time.  
Anything that doesn't apply, enter N/A.
Name
*
*
Email:
*
Address:
*
Phone
Guest
Name
*
*
Guest
Email:
*
Guest
Address:
*
Guest
Phone
*
Number of
Tickets -  
$45each
*
One or Two
Auction
Paddles?
*
Total $ To
Be Charged
Total $ = # of Tickets x $45.00
*
Visa or
MC?
*
CC
Number?
*
Security
Code?
*
Exp Date?
*
Name on
Card?
All Registrations are first come, first serve.  
This is a reservation request only.  You will
receive an email confirmation for your order.

By submitting this order, you are giving
Habitat for Humanity permission to charge
your credit card.
LEBANON COUNTY
ASSOCIATION of REALTORS®
Habitat For
Humanity  
Benefit Auction
Friday, November 3,     
at 6pm
Lebanon Country Club

Register On - Line by filling out
the form to the left. Credit
Card payment must accompany
registration.
Accepted Forms of Payment:
Visa/MasterCard.
Thank you for supporting
Habitat for Humanity!
Questions?
Email Kelly Whitman