OFFICIAL RAFFLE ENTRY FORM. Complete and mail this form to: 3333 Concours St., Bldg. 2, Ste. 2100. Ontario, CA 91764 or
OFFICIAL RAFFLE ENT RY FORM Complete and mail this form to: 3333 Concours St., Bldg. 2, Ste. 2100 Ontario, CA 91764
or fax it to:
951-769-6733 (Attn: Matt Gilson) DO NOT EMAIL
RAFFLE T ICKET ______ Single ticket(s) at $100 each .........................................................................Total Amount: $ _________
T ICKET INFORMAT ION Name To Appear On Ticket:_________________________________ Phone: _______________________ Mailing Address For Ticket: ______________________________________________________________ City: ____________________________________________ State: ________________ Zip:____________ Email: _______________________________________________________________________________
PAYMENT
[ ] Check enclosed – payable to SCPGA Foundation Or, please charge my (check one): [ ] VISA [ ] MasterCard [ ] American Express [ ] Discover Please print legibly so we may process your order without delay: Card #:__________________________________________ Expiration Date: _______ Security #:______ Name On Credit Card:_____________________________ Signature:_____________________________ Email:___________________________________________ Phone: _______________________________ Billing Address: ________________________________________________________________________ City: ____________________________________________ State: ________________ Zip: ____________