To charge your membership to your credit card, please do the following:
Please fill in the fields and print this form -- and then do either A, B or C
A) Press the Submit button which sends it as secure, encrypted e-mail to The Tuxedo Club;
B) Send it by post mail to the address above -- OR
C) Telephone Stephen at 205-491-7867 or 205-492-6879 and provide the information by telephone.
The Tuxedo Club
Credit Card Form
Post Mail to: Stephen L. Gilbreath, The TUXEDO CLUB, 1428 Virginia Road, Hueytown, AL 35023-8417
205-491-7867 or 205-492-6879 Standard E-mail (Not for credit): SLG@BigBandsAlive.com
Charter-Starter Membership -- Good thru 2006 -- $10
Charter-Bonus Membership -- Good till end of 2007 -- $25
Lifetime Charter Membership -- Black-Tie privileges! -- $250
For payment of -- please choose one of the Membership Options below:
From: Name and Address
(Full Name & Address as it appears on your credit card)
Message:
(Optional)
USD
Card number:
Expiration Date:
Name of the card holder:
Date:
Signature:
Press the Submit Button for High-Strength Encrypted (256 IBE!), Secure (SSL) Delivery
EncryptionMail by Secure Delivery -- Data maintained in Encrypted Form in our System.
After Submitting or Printing, press the Reset Button to clear the form.
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Benefactor's Kemosabe Club -- $1 or more (you decide amount).
