CityPass Discount Ticket Order Form																																							Customer Service (866) 276-2600
																																							Please mail or fax completed order form with payment to:
Please enter your Club Membership Website and Username:																												TicketSources.com
Website										Username																		9420 Reseda Blvd. #400
																												Northridge, CA  91324
																												Fax:		(818) 717-8961
Customer Information																					Ship To Information
																							SAME AS CUSTOMER INFORMATION
Customer Name																					Customer Name
Address																					Address
City										State			Zip								City										State			Zip
Phone								E-mail address													Phone								E-mail address
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Location							Description										Regular Price								Member Price						Quantity				Total
Atlanta							Adult Books										$	64.00							$	52.14									$
						May 24, 2008 - March 31, 2009	Youth Books (Age 3-12)										$	45.00							$	36.66									$
Boston							Adult Books										$	39.50							$	31.60									$
							Youth Books (Age 3-12)										$	21.50							$	17.20									$
Chicago							Adult Books										$	49.50							$	39.60									$
							Youth Books (Age 3-12)										$	39.00							$	31.20									$
Hollywood							Adult Books										$	49.95							$	39.96									$
							Youth Books (Age 3-12)										$	39.00							$	31.20									$
New York							Adult Books										$	65.00							$	52.00									$
						June 1, 2008 - March 31, 2009	Youth Books (Age 3-12)										$	49.00							$	39.20									$
Philadelphia							Adult Books										$	49.00							$	39.20									$
							Youth Books (Age 3-12)										$	34.00							$	27.20									$
San Francisco							Adult Books										$	54.00							$	43.20									$
							Youth Books (Age 3-12)										$	39.00							$	31.20									$
Seattle							Adult Books										$	39.50							$	31.60									$
							Youth Books (Age 3-12)										$	24.00							$	19.20									$
																																		Shipping & Handling:	$	2.50
NOTE:  CityPass tickets are shipped via Priority Mail																																		Order Total:	$
Bill To Information																				Payment Information
		SAME AS CUSTOMER INFORMATION																			Choose one:							VISA				Mastercard						AMEX
Customer Name
																												Check				Discover
Address																					Credit Card No																		Exp Date (mm/yy)
																																					/
City										State			Zip								Name on Card (exactly as it appears)
Phone								E-mail address													Cardholder Signature
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