Fun Card Purchase Form

UTC Ice Sports Center
4545 La Jolla Village Dr.
San Diego, CA 92122
tel: 858.452.9110 ext.0
www.utcice.com.
Fun Card Purchase Form
Name on Fun Card (skater's name)*

First NameLast Name
E-mail*
Cell Phone*

Area CodePhone Number
Enter Current Fun Card ID (Optional)

Select Amount*

Add $55 to Fun Card$50.00

Add $115 to Fun Card$100.00

Add $230 to Fun Card$200.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country