Print this Page to Order by Mail

Upon receiving your order, we will complete the ticket stubs with the name, address and phone number on your order and mail you your official ticket(s) along with a receipt of payment.

If you provide an email address, your ticket will be emailed to you.

Mail this order form to Clarence Rotary Club Foundation, P.O. Box 157, Clarence, NY 14031. If you are paying by check or money order please have it made payable to "Clarence Rotary Club Foundation". If you would prefer to pay by credit card please provide us with the appropriate information below.

(Photos are generic and not necessarily the model being given away) (Photos are generic and not necessarily the model being given away)	Name: ________________________________________________
	Address: ______________________________________________
	City: _________________________________________________
	State: ________________________________________________
	Zip: __________________________________________________
	Phone: ________________________________________________
	E-mail: _______________________________________________
	Where did you hear about the raffle? Rotary Member(name)_______________________________ Previous Supporter_____ Rotarian Magazine_____ Website_____ Facebook_____ Email_____ US Mail_____ Flyer_____ Radio_____ Lawn Sign_____ OldCarRaffle.com_____ DreamCarRaffles.com_____ Other:______________________________________________________________
	Number of Tickets at $50 each: ___________________________
	Buy 3 tickets and SAVE Number of 3 paks ( 3 tickets each ) at $100: ___________________________
	Buy 9 ticket WolfPack and get a chance on $2500 drawing Number of WolfPacks ( 9 tickets each ) at $300: ___________________________
	Credit Card Number: ____________________________________ Security Code:__________ (Note - we only accept Visa, Mastercard, and Discover Card)
	Expiration: ____________________________________________
Signature: ____________________________________________ I hereby authorize Clarence Rotary Club Foundation to charge my credit card listed above for the indicated number of tickets at $50 each or 3 paks at $100 per pak.