OFFICE USE ONLY – Raffle Ticket Order Form This is a TEMPORARY form that offers a CASH option for payment. Please enable JavaScript in your browser to complete this form.LayoutFirst Name *Last Name *LayoutStreet NumberStreet NameStreet Type StreetDriveRoadCircleCourtTerraceAvenueLanePlaceUnit/ApartmentLayoutCityStateZipcodeLayoutPhoneEmail *Please select how many tickets you would like to purchase: *1 FREE RAFFLE TICKET!3 tickets for $105 tickets for $158 tickets for $2011 tickets for $2525 tickets for $50 Pay by Cash or Credit Card *Cash (Select this for 1 FREE RAFFLE TICKET)CheckCredit CardStripe Credit CardCardName on CardStripe is a secure method of paying by credit card. Total$ 0.00Raffle Ticket Numbers *Before I hit SUBMIT, we would like you to take a brief survey to fulfill grant requirements. Your answer choices will be: YES!, WILL DO!, or I NEED HELP! Have you signed up for Nixle?Yes!Will do!I need help! How do I sign up?Have you signed up for MendoAlerts?Yes!Will do!I need help! How do I sign up?Have you signed up for SafetyNet?Yes!Will do!I need help! How do I sign up?Do you have the Broadcastify app?Yes!Will do!I need help to get it!Do you have a Cal Fire approved address sign?Yes!Will do!I need help! How do I order one!Would you like to have a FREE Home Hardening Inspection?Yes!Will do!I need help! How do I apply?Would you like to sign up for Chipper Days?Yes!Will do!I need help! How do I sign up?Do you need help clearing the Defensible Space around your home?Yes!Will do?I need help! Are you interested in volunteering with Sherwood Firewise Communities?Yes!NoNOTESSubmit
