PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

Senior Lunch November 2020

Your name

Your phone number

* I am RSVPing for:

	The FREE program online ONLY
	The FREE program online AND I'd like to order lunch(es)

LUNCH OPTIONS:

# of Corn Beef

# of Turkey

# of Egg Salad Lunches

SIDES:
Choose one side per meal above (soup OR salad), not both.

Sides: # of Matzo Ball Soup(s)

Sides: # of House Salad(s)

If you are ordering food, are you able to pick up your food order?

	Yes
	No, I need assistance

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

Senior Lunch November 2020

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Senior Lunch November 2020

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Image Preview