Car Draw Ticket Order Form

Chippawa Lions Club

Please print off the form, fill it out and mail with your cheque or money order to:

Chippawa Lions Club
P.O. Box 935
Niagara Falls, Ontario, Canada
L2G 6V8

Please make cheques or money orders payable to: Chippawa Lions Club

Please send me	________ tickets.( $2.00 each, 3 for $5.00 or 15 for $20.00)
Total amount enclosed:	$ _____________
Name:	_____________________________________
Address:	_____________________________________
	_____________________________________
City:	_____________________________________
Province/State:	_____________________________________
Country:	_____________________________________
Postal/Zip Code:	_____________________________________
Telephone Number: (include area code)	_____________________________________

Tickets will be mailed once payment has been cleared by our bank( for personal cheques).