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: ___________________________
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.