Clay Shoot Transactions – Christus Southeast Texas Foundation

Name*

First Last

Company

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Around the World Game

Price: $10.00 Quantity:

Individual Mulligan

Price: $15.00 Quantity:

Team Mulligan

Price: $50.00 Quantity:

Team Flurry

Price: $50.00 Quantity:

Golf Cart

Price: $100.00 Quantity:

Individual Shooter

Price: $150.00 Quantity:

Team

Price: $600.00 Quantity:

List of Additional Charges

Amount of Additional Charges

Payment Information

Total

$0.00

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American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State ZIP Code

Total

$0.00