| Payment Transaction Form 2000 CIAA Basketball Tournament February 28-March 4, 2000 Raleigh, North Carolina |  | Print out and send to: CIAA Tournament Tickets c/o Nicole Nelson P.O. Box 7349 Hampton, VA 23666 Fax: 757-865-8436 E-Mail: NelsonCIAA@aol.com |
| Name: (As it appears on credit card) | _______________________________________ |
| Address: (Billing) | _______________________________________ _______________________________________ |
| City/State/Zip: | _______________________________________ |
| Phone Numbers: (Include area code) | Daytime:_____________________________ Other:_____________________________ |
| Ticket Purchase Request | No. of Tickets | Amount |
|---|---|---|
| Club Level Seating *LIMITED* Larger seats, Push-Button Concessions and limited access area - $125 ea. | __________ | __________ |
| Priority Level Seating *LIMITED* Center Court seats on each side of the arena with restaurant entrance. - $105 ea. | __________ | __________ |
| Lower Level Seating - $95 ea. | __________ | __________ |
| TOTAL: | __________ | __________ |
MY SIGNATURE ASSURES THAT I UNDERSTAND THAT ALL CLUB & PRIORITY LEVEL SEATS ARE NOT GUARANTEED. ALL TICKETS ARE SOLD ON A FIRST-COME-FIRST SERVED BASIS ONLY! PATRON WILL RECEIVE NON-CLUB OR NON0PRIORITY SEATING AND A REFUND OF THE DIFFERENCE IF THE REQUESTED SEATS ARE NOT AVAILABLE. SIGNATURE (IF APPLICABLE) _______________________________________ CREDIT CARD INFORMATIONCREDIT CARD TYPE (CIRCLE ONE) VISA MC AMEXCREDIT CARD #VISA/MC _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ EXP DATE __________ AMEX _ _ _ _ - _ _ _ _ _ _ - _ _ _ _ _ EXP DATE __________ |