HOSPICE
LOTTERY APPLICATION FORM How Your
Local Hospice Lottery Works - click here You may pay for
multiple chances to run for as many weeks as you wish. Cheque or Standing
Order |
| Name | ............................................................................................. |
| Address | ............................................................................................. |
| Address (cont.) | ............................................................................................. |
| Postcode | ............................................................................................. |
| Tel. No. | ............................................................................................. |
| CHEQUE PAYMENT | ||||
| Each chance costs £1.00 per week | ||||
| I wish to buy | ............ | chances each week for | ............ | weeks and |
| remit: £............ | cash / cheque made payable to "Your Hospice Lottery" | |||
| STANDING ORDER FORM | ||||
| Reference No. (for office use only) ............................................... | ||||
| To | ............................................................................... Bank PLC |
| Branch | ............................................................................................. |
| Account Name | ............................................................................................. |
| Account Number | ............................................................................................. |
| Sort Code | ............................................................................................. |
| Please debit my account and send as per the following details: | |
| Barclays Bank, Farnham | |
| Payee: TC Lottery Ltd | |
| Account Number: 50099244 Sort Code: 20 31 06 | |
| First Payment on ...................................................... and thereafter | |
| (*EACH PAYMENT IS A SINGLE PAYMENT PER QUARTER/HALF YEAR/ANNUM - UNTIL FURTHER NOTICE) | |
| (Amount to be debited) | |||
| Quarterly | ............. | chance(s) x £13 = | £ ............................. * |
| Half Yearly | ............. | chance(s) x £26 = | £ ............................. * |
| Annually | ............. | chance(s) x £52 = | £ ............................. * |
| until further notice | |||
|
Signed
..................................................................................................... |
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| Please
return completed form to: Your Local Hospice Lottery 4 West Street, Farnham, Surrey GU9 7DN Telephone: 01252 728 411 Fax: 01252 728 455 Your
local Hospice Lottery is promoted by Tuckwell Chase Lottery Ltd., 4 West
Street, Farnham, Surrey GU9 7DN Registered
with Waverley Borough Council under Section 5 of the Lotteries and
Amusements Act 1976. The
Phyllis Tuckwell Hospice, Farnham – Registered Charity No. 264501
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