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Purchase a Ticket With a Credit Card







The cost of tickets is $10.00 for one ticket or

a book of eleven tickets for $100.00


Ticket Order Form - Dinner for Two Anywhere


For a printable copy of the tircket order form, please click here.

Complete this form, with your credit card information and mail the form to:

Coboconk Lions, Box 316, Coboconk, L0M 1K0       attention - Elaine


Address: ________________________________________________________________

City/ Town: _________________________

Postal Code/Zip: _______________

Province/State: ______________________

Country: ______________________

Email: __________________________________________________________________


Cell: _________________________


Credit Card Information

       O   VISA               O   Master Card

Card Number:   ___________________________________________________________

Expiry Date: _______________________

CVV (3 digits on back)   __________ 


Ticket Order Form

Number of tickets @ $10.00    ___________

Total Cost of tickets:  ____________

Number of Books of tickets     ___________

Bonus - a book has 11 tickets for $100.00


Total Cost of book(s) ____________

If you are planning to give a ticket or book of tickets as a gift to another person, the name on the ticket must be older than 18 years.  List the name and contact information of the person receiving the gift here:


Phone/Email: _____________________________________________________________

O   please mail my ticket stub(s) to me


O   by completing this credit card form and mailing the information to Coboconk Lions, Box 316, Coboconk, Ontario K0M 1K0 - attention  Elaine;  I am therefore authorizng the Coboconk Lions Club to charge my credit card for the total ticket(s) amount owing.