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TCA North Texas PAC Fundraiser

Required field(s) are indicated by an *.
* Name
Phone
* Email
* Occupation
* Number of tickets	12345678910 $50 per ticket
Guest(s) Name
Additional PAC Donation Amount
Total
* Name	Name as it appears on the credit card
*Billing Address
*Billing Zip
Type	VisaMasterCardAmerican ExpressDiscover
* Number	Credit Card Number
* Exp. Date	mm/yyyy
* This is a non-corporate card