Lawrenceville Lodge #563 PHA Online Store

Full Name

First NameLast Name

E-mail

example@example.com

Contact Number

Format: (000) 000-0000.

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Is shipping address same as billing address?

Shipping Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Send Gift?

Recipient's Full Name

First NameLast Name

Gift Message

Special Instructions

$50 Visa Gift Card

This is to purchase a ticket for the drawing for a $50 Gift Card.

$1.00 Quantity

Fish Plate

The Fish plate will consist of: 2 Fresh Tilapia Fish, French Fries, Bread, and your choice of drink

$8.00 QuantityDrink

Chili Dog Plate (2 Chili Dogs, Fries, Drink)

$8.00 Quantity

Subtotal

Tax

Total

Credit Card

Apple Pay

Google Pay

Cash App Pay