Form

Lindy 500 - Annapolis Limo Rally 2011 Payment Form
Name:*
Email:*
Phone #:*
Address:*
City:*
State:*
Zip Code:*
Team Name:
How Did You Hear About The Lindy 500?:
Payment Information:
Type of Credit Card:*
CC Number:*
Exp. Date:*
CCV #:*
I agree to allow Lindy Promotions to charge my credit card $250 to reserve my team's spot, which is fully refundable until Thursday, April, 14th at 5pm. The remaining, non-refundable balance of $250 will be charged to my credit card on Friday, April 15th. All participants must be 21+.
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Lindy 500 - Annapolis Limo Rally 2011 Payment Form