This document contains account and payment information for ticket purchases, including the company name, contact details, payment method, and signature authorizing the purchase. It also includes information about purchasing student tickets to a men's basketball game at School Street Elementary School, with prices for individual student tickets, student and parent tickets, and classroom packages.

1. Account Information:
Company Name __________________________________
Contact Person ___________________________________
Address _________________________________________
City _______________________ State ____ Zip ________
Phone #___________________ Fax __________________
E-mail __________________________________________
Payment Information:
Check # __________________________ Amount due ___________
Credit Card # ______________________ Amount due ___________
Credit Card Type: Visa/MasterCard/Discover/American Express
Exp. Date _______ V-code ________
Ticket Office Manager: Melissa Curran Phone # 716-375-2500 Fax # 716-375-2280
This signature hereby authorizes the purchase of tickets by this check or credit card and the acceptance of responsibility
for payment in full of tickets purchased.
X_________________________________________________________________ Date________________________
With your help, we can send every 3rd, 4th, and 5th grade student
from School Street Elementary School in Bradford to our last men’s
home game of the season.We want every bit of help we can to rock
the Reilly Center and your donation can make sure we have a full
house for the last night of our 2014-2015 season!
Ticket Prices # ordered
1 student: $11.00 ________
1 student + 1 parent: $22.00 ________
1 Classroom*: $275.00 ________
1 Classroom w/parents: $550.00 ________
# of tickets purchased: ________
Price (#tickets x $11.00): ________
*1 Classroom = approx. 25 students