Application for Swormville VFC

1st Annual Big Bucks raffle  

Please print clearly  

Name of the person in charge of this ticket:

Name _________________________________________

Address _______________________________________

City __________________________________________

State _______________ Zip Code __________________

Area Code _____  Telephone ______________________

 

Additional Names on the Ticket:

______________________________________________

______________________________________________

______________________________________________

______________________________________________

 Please make $100.00 donation payable to:

Swormville Fire Company

Please return by May 15th 2009

and mail to:

Swormville Fire Company

Attention:  Raffle Chairman

6971 Transit Road

East Amherst , NY   14051

 

 If available, Ticket # requested (1 -400)

 ___________________________________

After payment is received, the official ticket

will be sent to person in charge of the ticket