BINGO NIGHT WAITLIST Please fill out the boxes below to be put on a waitlist Name(Required) First Last Business Name(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Brief Description of Merchandise(Required)Your item for the vendor raffle(minimum of $50 in value)Is an electrical outlet require?(Required) Yes No If an electrical outlet is required please explain whySpace fee (includes an 8ft table with a linen)(Required) Cost is $200 Space fee for 1 additional table (includes an 6ft table with a linen)(Required) None Cost is $50 Payment Method Credit Card Subtotal $0.00 If you would like to pay for the 3.5% processing fee please click YES below YES Subtotal $0.00 CC Processing Fees Price: $0.00 Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Use your camera to go to the Venmo page to pay
