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/ApartmentLayoutCityStateZipcodeLayoutPhoneEmailPlease 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 NumbersBefore 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?Done!Will do!I need help! How do I sign up?Have you signed up for MendoAlerts?Done!Will do!I need help! How do I sign up?Have you signed up for SafetyNet?Done!Will do!I need help! How do I sign up?Do you have the Broadcastify app?Done!Will do!I need help to get it!Do you have a Cal Fire approved address sign?Done!Will do!I need help! How do I order one!Would you like to sign up for Chipper Days?Done!Will do!I need help! How do I sign up?Would you like to have a FREE Home Hardening Inspection?Done!Will do!I need help! How do I apply?Do you need help clearing the Defensible Space around your home?Done!Will do?I need help! Are you interested in volunteering with Sherwood Firewise Communities?Done!Will do!Need help!NOTESSubmit
