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Raffle Form

Raffle Form

Chabad on Campus Raffle 2017


grand prize $10,000 ~~second prize $1000~~ third $360

First Name*:                      

Last Name*:                      

Email address*:                 

Confirm Email Address*:    

Phone Number*:                


Number of tickets:


We can accept Visa and Mastercard credit cards and all debit cards (not AMEX) 

Card Type*:        

Name on card*:          

Billing Address*:   





Card Number*:         

Security Code*:   

Expiration Date*:                    


Please note: Your ticket/s will be issued once we receive confirmation of a successful payment. This is not immediate in our system. You will receive an email confirmation of a successful purchase.

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Raffle 2017

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