Terre Haute Symphony Orchestra Ticket Order Form

    Print this form and fill in the details, and then mail it in with payment.

Name: ______________________________________________
Address: ____________________________________________
             _____________________________________________
City: ____________________________  State: _____ Zip: _____
Day Phone: _______________  Evening Phone: ________________

Email Address: _________________________________________
I would like to receive email updates:  Yes ___    No ___

Zone Choice (check):  Platinum ___    Gold ___    Silver ___
        1.Number of Seats:                                       ________
        2.Price per Ticket:                                         ________
        3.Total Ticket Price:                                     ________
        4.Processing Fee:                                              $3.00
        5.ISU Facilities Fee (no. tickets x 5)          _________
           ($5.00 fee per ticket used for capital improvement)

                                            Grand Total: $________________

All orders must be paid in full before tickets can be mailed. Indicate payment method:

___ Payment is enclosed (make checks payable to Indiana State University/THSO)

___ Please charge my account:   Master Card ___    Visa ___  (sorry, no others accepted)

               Account number: __________________________  Exp. Date ____________

Signature ___________________________________________________________

Please mail this order form and payment to:
ISU Hulman Center Ticket Office
200 N. 8th Street
Terre Haute, IN 47809