purim raffle.jpg

Yes I want to participate in the £500 Cash Prize raffle being drawn on Purim, 21st March 2019. 

1 Ticket - £5

3 Tickets - £10

10 Tickets - £25

25 tickets - £50

50 tickets - £85

75 tickets - £120

100 tickets - £150

200 tickets - £300

300 tickets - £400

400 tickets - £500

 

Please use the form below for card payments

* =mandatory fields

Contact & Billing information

First Name*:

Last Name*:

Address*:

City*:

Province/ State:*

Post Code/ Zip*:

Country*:

Phone Number*:

Email*:

Payment Amount*: £

Card Number*:

Expiry Date (MM/YYYY)*:

Security code (three numbers on the back of your card)*:

Message:

I allow my name to be mentioned on facebook. (This will encourage others to buy!)

PLEASE ENSURE ALL FIELDS ARE FILLED IN OTHERWISE FORM WILL NOT GO THRU!