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I WOULD LIKE TO PURCHASE:
_________ # Table(s) at $175 each table (six seats per table) = $__________
Name/Business Name: ________________________________________________________
Contact Person: ______________________________________________________________
Address: ___________________________________________________________________
City: ___________________________________ State: ______________ Zip: _____________
Telephone Number: _______________________E-mail: _______________________________
Payment (MasterCard or Visa)
Card # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date: _________________
Name on the Card: ___________________________________________________________
Signature: _______________________________________ Billing Zip Code: ______________
Make checks payable to: City of Ellisville
Mail to: City of Ellisville
1 Weis Avenue
Ellisville, MO 63011
Please reserve and pay by October 13, 2023
For additional information contact:
Ada Hood at ahood@ellisville.mo.us