2012 CAR RAFFLE ORDER FORM

Choose your ticket number!
Get a jump on the 2012 Car Raffle by purchasing your lucky ticket now! Choose a 4-digit number between 0001 and 2000 (first come, first served). Each ticket is $100. Winner gets a $60,000 voucher towards their dream Porsche or a $50,000 cash!

PERSONAL INFORMATION

Title:
First Name:
Required
Last Name:
 Required
Address:
Required
City:
Required
State:
 Required
Zip:
 Required
Phone:
Required
Email:
Required
What social media site did you hear about the raffle?
FourSquare  
Facebook Linked In
Twitter Other
 

How did you hear about the car raffle?
Brochure  
Email  
Board Member
Website
Publication
Other

 

PAYMENT INFORMATION

Number of Tickets: x $100 =

Card Type:
 Please select an item.
Name on Card:
 Required
Card Number:
 Required Required
Expiration Date:
 Required RequiredRequired
Security Code
3-digit code located on the back of MasterCard, Visa and Discover.
4-digit code located on the front of American Express.


Billing address same as above

Bill Address:
Bill City:
Bill State:
Bill Zip:

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