____________________________________
 
Ticket Order Form

YES!

 

I want to help in your fundraising efforts to continue your charitable projects. Please send me _____ raffle ticket(s) at $25.00 each (or 5 for $100.00).

3 Ways to pay for your tickets:

1) Use Goggle CheckOut (preferred)

2) Charge my MASTERCARD, VISA or AMERICAN EXPRESS credit card, see below.

3) I have enclosed a check or money order for $__________made payable in U.S. funds only to the Rotary Club of Bailey’s Crossroads, so please "print this" page and "mail -or- fax it" to us...and Thank you for your support!

 

_______________________________________
Name

________________________________________
Address

________________________________________
City

________________________________________
State

________________________________________
Zip Code

________________________________________
Telephone Number

________________________________________
E-Mail Address

 

 

 

 

 

 

 

 

Method of Payment

Check

Money Order

Visa

MasterCard

AMERICAN EXPRESSS


I am using Goggle CheckOut on-line
It's fast, free and secure!
-or- use your Credit Card via Goggle
even IF you do not have a Goggle account.

Thank You for YOUR support!


____________________________________
your Credit Card Number
(Only if mailing in the order form)

_____________/ (_______________)
Expiration Date -/- ( 3-4 digit Sec Code)


____________________________________
Name on Card

____________________________________
Signature (Required)

Please print and fax this form to: 703-931-8770 (for credit card order only)

-or- mail along with check or money order to:

The Rotary Club of Bailey's Crossroads
P.O. Box 1510
Bailey's Crossroads , VA 22041

Virginia Charitable Gaming Permit Number N-11-0442-13206

The Virginia Department of Charitable Gaming rules and regulations shall be the controlling
factor for all raffle activity undertaken by the Bailey’s Crossroads Rotary Club.

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