Chesterton Raffle Purchase

Chesterton Academy Grand Raffle Ticket Purchase
Winning Tickets to be Drawn at the Chesterton Gala
March 1, 2025

(800 tickets to be sold and need not be present to win)
Grand Prize - $10,000 2nd Prize - $5,000 3rd Prize - $2,500
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Seller (e.g. student/house)
Date Sold

MonthDayYear
Number of Tickets*
$100 Per Ticket
Ticket Cost
Cover Our Bank Fees? (2.9% + 0.30)

yes
Total

Raffle Tickets

USDTotal Purchase Amount

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: