Crime Stoppers Honolulu
14th Annual Denim & Diamonds Gala
Secure Payment Form
Order Summary (Event Date: April 10th, 2020, Honolulu Country Club, 5:30pm-9pm)
Order Date
Platinum Table Sponorship $7,500 (Table of 10)
Diamond Table Sponorship $5,000 (Table of 8)
Gold Table Sponsorship $3,500 (Table of 8)
Silver Table Sponsorship $2,500 (Table of 8)
Bronze Table Sponsorship $1,500 (Table of 8)
Individual Tickets: $100 per person
Convenience Fee (3%)
Total Order Amount
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID Number
ATTENDEES:
Name / Company
Name / Company
Name / Company
Name / Company
Name / Company
Name / Company
Name / Company
Name / Company
Contact Information
Company Name (if applicable)
Contact Person
Phone Number
Email Address
Street Address
City
State
Zip
Please verify the accuracy of the above information before submitting. No tickets will be issued. Guests will be verified against the listing you provide above.
Submit
www.honolulucrimestoppers.org
Contact: Crime Stoppers at (808)955-8300
Supported by AXIA PAYMENTS HAWAII