David Lipscomb High School Reserved Seating Application And Payment Authorization Name________________________________________________ Address______________________________________________ City___________________State_____Zip___________________ Daytime Phone_________________________________________ EMAIL ______________________________________________   For Booster Club Record.  Please do not write below: RESV #_____________________ Section_______ Row_____/______ Seats________________________        /________________________       Total Number of Seats to purchase______________ (6 maximum) Total Amount @$175.00 each      ______________(+) Total Payment                              $_____________(=) Today's Payment:   ______Check    _____ Credit Card        _____Visa    _______Master Card    _____Discover Account Number _______________________________________ Name as it appears on Card _______________________________ Card Billing Address_____________________________________ _____________________________________________________ Expiration Date____________ Service Code  (on back)__________ Amount to be billed  $_____________Date_____________ ___________________________________________ Authorized Signature ----------------------------------------------------------------------- Please read over terms and conditions.  You must sign accordingly before your application can be processed.  Thank you for your support of the Mustang Booster Club and David Lipscomb High School Athletics. Please list your choice of seats below: First Choice Row_____/______ Seats_______________________        /_______________________ Second Choice Row_____/______ Seats_______________________        /_______________________ PAYMENT INSTRUCTIONS:   Please download this form and fill it out completely and include a check or credit card information and mail it to: Dee Dee Ralston 2456 Hidden River Lane Franklin, TN  37069