ORDER FORM

Chances are $30.00 each/2 Chances for $50.00/5 Chances for $100.00/12 Chances for $200.00/50 Chances for $600.00

Another way to buy tickets is to print out this form, fill it out, and fax or send it to:

Interfaith Airport Chapels of Chicago
P.O. Box 66353
Chicago, Illinois 60666
Fax: 773/686-0130
Please call us with questions at: 773/686-2636

Name                                                                                                Number of Tickets             


Address                                                                                                  Amount $                 


City                                                                          State          Zip Code           


Phone Number                                                                               


Payment Method (Please Circle One):

Check (made payable to Interfaith Airport Chapels of Chicago)

VISA    Master Card    Credit Card #                                                                             

Exp. Date           

3 digit code on back of Credit Card           


Signature                                                                                  


Please send me a confirmation notice (please circle):    yes    no

Thank you for your generosity!