Luminary Fundraiser

Luminary Order Form

"*" indicates required fields

Luminary Quantity*

Price: $10.00

Quantity

Please list how the name should be printed on each luminary, including whether it is in memory or in honor of the person.*

Total

Name*

First Last

Billing Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Phone Number*

Email*

Please wait for your payment to be processed in the next section before exiting the order form. It will take a few moments to process. You will receive a confirmation once your payment is successful. Venmo payments will take longer to process than PayPal and credit card payments.*

I understand

Payment Method

PayPal CheckoutCredit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date   Security Code Cardholder Name

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