NEW Chabad 107 Draw / Club

Form ID
NEW Chabad 107 Draw / Club
Chabad Buckhurst Hill is launching a new way to support our vital work — and give you a chance to win cash prizes!

For just £5 per month, you’ll receive one ticket in our quarterly prize draw.

🗓 Draws take place on the first Sunday of January, April, July and October
🏆 Prizes:
• 1st prize – £107
• 2nd prize – £50
• 3rd prize – £25

How many tickets can I have?
• £5 per month = 1 ticket per draw
• £10 per month = 2 tickets
• Up to a maximum of 6 tickets per person

How to set up your donation
After submitting this form, you will receive an email with instructions on how to set up a Standing Order via your bank or online banking.

Alternatively, if you choose to pay annually, you can enter your bank details below.
Name*

PrefixFirst NameLast Name
Contact Number*
Email*

Confirmation Emailexample@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I wish to donate ...

Monthly via Standing OrderAnnually - One off payment
I will set up a Standing Order for: (Once you click submit we will send you our bank details so that you can set this up)

£5 per month = 1 ticket£10 per month = 2 tickets£15 per month = 3 tickets£20 per month = 4 tickets£25 per month = 5 tickets£30 per month = 6 tickets
Please indicate the date of the month you will start this from.

DayMonthYear
Date
I wish to donate annually to the 107 Draw (each ticket costs £5). How many tickets would you like?
Annual amount
Gift Aid

Please tick here if you are a UK Tax Payer and your donation can be counted as Gift Aid. Thank You!
Payment Amount

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