DreamCarRaffles.Com
801 S. Durkin Drive
Suite B
217-546-1009-TELE
217-546-1033-FAX
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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