Sip and Shop

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Name*

First Last

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code

How Many Will you be attending*

You are required to put the names of the people attending, with you, if more than one. This does NOT include you

Second Person Name*

First Last

Third Person Name*

First Last

Fourth Person Name*

First Last

Fifth Person Name*

First Last

Sixth Person Name*

First Last

Seventh Person Name*

First Last

Eighth Person Name*

First Last

Ninth Person Name*

First Last

Tenth Person Name*

First Last

Subtotal

$0.00

If you would like to pay for the 3.5% processing fee please click YES below.

YES

CC Processing Fees

Price: $0.00

Total

Credit Card*

American Express

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MasterCard

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Card Number

Expiration Date

Security Code Cardholder Name