____________________________________
 
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).
I have enclosed a check or money order for $__________made payable in U.S. funds only to the Rotary Club of Bailey’s Crossroads, or charge my MASTERCARD, VISA or AMERICAN EXPRESS credit card, -OR- use PayPal on-line to Buy Now..

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

 

 

Official PayPal Seal

 

 

 

 

 

Method of Payment

Check

Money Order

Visa

MasterCard

AMERICAN EXPRESSS


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

<== $25 per ticket / Specify QTY
<== $100 BONUS BUY / 5 Tickets
Solution Graphics


____________________________________
Credit Card Number

_________________/___________________
Expiration Date / (3-4 Security Code)


____________________________________
Name on Card

____________________________________
Signature (Required)

Please print and fax this form to: 703-560-3807 (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-08-0442-12220
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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