DreamCarRaffles.Com

801 S. Durkin Drive

Suite B

SPRINGFIELD, IL  62704

217-546-1009-TELE

217-546-1033-FAX

swb41450@yahoo.com

 

 

Yes, We wish to participate in this website promotion to benefit our organization. 

  

Organization Name_________________________________
Drawing Date________/_________/__________ (Month/Day/Year)

Address_______________________________

             _______________________________

Contact Person_________________________
Telephone #___________________________
Fax #              _________________________
Website Address_______________________
E-Mail Address________________________    


Please circle the following options and make check or money order payable to DreamCarRaffles.com:

 

 

1.      Regular Listing - $129:  Attached is one original color photo and program information. Please prepare ad copy for us.  Our website address is: http://www.___________________________  

2.    Web Counter – $20 (Optional)
       


Note: If you have program copy available on your PC diskette, please send it along with this registration form.



__________________________

             Authorized Signature

 

 

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