July 4th Raffle Ticket Order Form

To order by credit card, please fill out the form below. Thank you for your support!

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First Name *

Last Name *

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Street Number *

Street Name *

Street Type *StreetDriveRoadCircleCourtTerraceAvenueLanePlace

Unit/Apartment

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City *

State *

Zipcode *

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Phone *

Email *

Please select how many tickets you would like to purchase: *3 tickets – $ 10.005 tickets – $ 15.008 tickets – $ 20.0011 tickets – $ 25.0025 tickets – $ 50.00

Stripe Credit Card *

Card

Name on Card

Stripe is a secure method of paying by credit card.

Total

$ 0.00

Please complete the brief survey below and earn a FREE RAFFLE TICKET!

 

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!

Do you have a CAL FIRE approved address sign? *

• Yes
• Will do!
• I need help! How do I get 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?

Would you like to help Sherwood Firewise by becoming a volunteer? *

• Yes
• No

Submit