Dream House Raffle Entry Form

Project Uplift NFP

Dream House Raffle Official Entry Form

(Form will be available for download once the Raffle Tickets are officially for sale)

Please print legibly so we may process your order without delay:

Number of Tickets:  ____________________ x $20 per ticket = Total Amount $ _________________

€ Check enclosed, payable to:  Project Uplift NFP
OR, please charge my (check one):
€ VISA          € MasterCard          € Discover       €American Express

Card Number: _____________________________________________________________________

Expiration Date: _________________________________ Security Code*: ____________________

*Last three numbers on signature line on back of credit card, or four digits on the front of American Express, above the account number.

Signature: _________________________________________________________________________

Email Address: _____________________________________________________________________

Name on Credit Card: _______________________________________________________________

Billing Address: ____________________________________________________________________

City: ______________________________________________ State: _________ Zip: ____________

Phone (include area code): _________________________________________

Name to Appear on Ticket: ___________________________________________________________

Mailing Address for Ticket: ___________________________________________________________

City: ______________________________________________ State: __________ Zip: ____________

Phone (include area code): ____________________________________________________________

How did you hear about the raffle? _____________________________________________________

I was referred by: ____________________________________________________________________

Your numbered ticket receipt(s) will be mailed to you after your check or credit card is processed.  This will take a minimum of four weeks.  The raffle ticket(s) with matching numbers will be placed in the official drum for the drawings.  All entrees received before the drawing deadline(s) will be entered into the associated drawing and all subsequent drawings whether or not stubs have been mailed.  Please note that during the drawings we call names, NOT NUMBERS.  ALL SALES ARE FINAL.  NO REFUNDS.  Only 10,000 tickets will be sold.  Must be 18 years or older to enter.  Void where prohibited.  Raffle subject to official rules & regulations.  All Rights Reserved.