"*" indicates required fields Your InformationName* First Name Last Name Email Address* Phone #*Bingo EntriesBingo Entry Fees Quantity* Price: $30.00 Quantity Entry Fee $30.00/playerPurchase Additional Bingo Cards (Optional) Quantity Price: $5.00 Quantity Additional Bingo Cards $5.00 eachTotal Due Are you purchasing additional tickets for guests? Yes, I'd like to provide guest names Please provide the names of your guests in the space below.Payment InformationPayment type:* Payment by Credit Card Payment by Check Processing Fee Make my purchase go further. Please increase my bingo entry fees by $1.50 per entry to help cover processing fees. Amount to be charged: Credit Card*Card Details Cardholder Name Billing Address* Street Address City StateAlabamaAlaskaAmerican 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 Payment by Check To pay by check: Please complete the form on this page. Make your check payable to the BridgeMill Sixes Service League. Mail to: Sixes Road Suite 126 Box 185 Canton, GA 30114Please mail a check for the amount:
