Win $100,000 CASH | |||
For A Donation of $100 Win: |
For A Donation of $36 Win: For A Donation of $18 Win: |
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Drawing will take place on April 13, 2016 | |||
1 Ticket | $100 | 5 Tickets | $375 |
2 Tickets | $180 | 7 Tickets | $500 |
3 Tickets | $250 | 15 Tickets | $1,000 |
Amount of Tickets | |||
Your Information | |||
First Name | Last Name | ||
Address | City | ||
State | Zip | ||
Phone | |||
Payment Information | |||
Card Type | Card Number | ||
Expiration | CVV Code | ||
Amount to Charge |