New Grand Raffle Ticket Order Form

The New Grand Raffle

Grand Raffle Ticket Order

*Credit card orders will incurr a 3% credit card processing fee.

First Name: 

Last Name: 

Address 1: 

Address 2: 

City:   State:   Zip: 

Phone: 

Email: 

I am interested in purchasing:   tickets

I am purchasing tickets on behalf of:

Billing Information:

Credit Card Number: 

Experation Date:  / 

CVC Code: 

Billing Zip Code: 

Confirm Ticket Quantity & Total Price with Processing Fee

I understand and approve a 3% credit card processing fee that will be added to my total.

I authorize Queen of the Rosary to charge my credit card.

   *Without this authorization Queen of the Rosary cannot process your order.



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