Total $____________________
Name_____________________________________________________________
Address___________________________________________________________
City __________________________State__________ Zip Code ______________
Phone ___________________ Email _____________________________________
Method of Payment : _____Cash ____Check ___Credit Card
Credit
Card Number_______________________________________ Exp.Date___________
Signature__________________________________________
Date__________________ Order taken by_____________ Ticket #’s_____________
Date Mailed/Picked up______________ or Will Call________________staff________
Inyo Council for the Arts
137 South Main Street Bishop, CA 93514
Phone: 760-873-8014 FAX: 760-873-5518
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