National Humane Society

Charity Raffle

Secure Order Form

Please select the number of tickets you wish to purchase. (Tickets are $100.00 each)
Please send me 3 raffle tickets and get 40 free
  Please send me 1 raffle ticket and get 9 free
Please send me 10 raffle tickets and get 150 free

You will receive an email with your ticket number(s) within 48 hours. Please supply the following information:
Full Name (required)
Address (required)
City (required)
State  Zip:    (required)
Phone # (required)
Email: (required)

Choice of prize? (select one)
$50,000.00 Cash
Classic 1965 Corvette
Cadillac Escalade
Range Rover
Ford Raptor Pickup Truck

Where did you see our ad? (select one)
Magazine Postcard Online Facebook

Your payment information:
Select one: Visa MC Amex Discover
Note: for American Express, please enter four numbers in the boxes below, except for the last box, please enter three numbers.
Credit Card Number   (required)
Exp. Date / (MM/YY) (required)