2017 OFFICIAL TICKET REQUEST
PURCHASER INFORMATION
Mr.
Mrs.
Ms.
Miss
Dr.
HE
Complete the Official Ticket Request and send it along with your cheque, money order, or VISA, MasterCard or AMEX number.
Official Ticket(s) will follow by mail. Tax receipts cannot be issued. Only 33,200 tickets will be sold.
AL
TH
C A R E F O U N DA
TIO
H O S P I TA L
N
LOTTERY
First Name_________________________________________________________________________________________________________ Last Name____________________________________________________________________________________________________
Suite/Apt.___________________ Address________________________________________________________________________________________________________________________________________________________________________
NL
City/Town___________________________________________________________________________________________________________________________________________________ Province_____________
Postal Code_________________________________________
Phone: Work (
)____________________________________________ Home (
)_____________________________________________ Cell (
)______________________________________________
Email_________________________________________________________________________________________________________________________________________________________________________________________________________
Check to receive text alerts
Standard mobile rates may apply.
Age
19-24
25-34
35-49
50- 64
65+
The provision of age information is optional and used only for internal marketing and statistical purposes.
LIMITED
QUANTITIES
TICKET ORDER
INFORMATION
Your personal information is collected and used for two purposes only; to fulfill your order and to notify you about future Health Care Foundation Hospital Home Lotteries. The Health Care Foundation does not sell, trade or lease your personal
information. If you wish to be removed from our contact lists, please check here , call 1-866-992-1899 or 753-1899, or email [email protected]. For ticket inquiries, please call 1-866-764-7088. The following are excluded from purchasing tickets: partners
and employees of Deloitte LLP and its affiliates, senior administrators, board members of the Health Care Foundation and their dependent family members. The liability of the licensee of this lottery shall be limited to the purchase price of the ticket(s).
HCF HOSPITAL HOME LOTTERY TICKET ORDER INFORMATION
________single ticket(s) at $100 each. Total $______________.
50/50 ADD-ON® TICKET ORDER INFORMATION
________single 50/50 Add-On(s) † at $10 each. Total $______________.
50
50
_____
ADD-ON
________3-pack(s) u at $250 each. Total $______________.
________5-pack(s)u of 50/50 Add-Ons† at $25 each. Total $______________.
________5-pack(s) at $375 each. Total $______________.
________15-pack(s) u of 50/50 Add-Ons† at $50 each. Total $______________.
u
____ $500 SUPER PACK(S)
u
TOTAL:
Includes 6 – Home Lottery Tickets, 15 – 50/50 Add-On Tickets and 3 – Cash Calendar Add-On Tickets.
$____________________
Make cheque or money order payable to: Health Care Foundation Home Lottery 2017. (Please, no post-dated cheques)
(Check only one)
Cheque
Money Order
MasterCard
VISA
AMEX
CASH CALENDAR™ ADD-ON TICKET ORDER INFORMATION
________single Cash Calendar Add-On† at
$20 each. Total $_______________.
________3-pack(s) u of Cash Calendar Add-Ons†
at $50 each. Total $_______________.
TOTAL ORDER AMOUNT $________________
(Home Lottery tickets, 50/50 Add-On Tickets and Cash Calendar Add-On Tickets)
Mail to: H
ealth Care Foundation Hospital Home Lottery
PO Box 7370 Station C
St. John’s, Newfoundland A1E 3Y5
uEach HCF Hospital Home Lottery ticket in a 3-pack or 5-pack,
and each Add-On ticket in a 3-pack, 5-pack or 15-pack, and
each ticket in a Super Pack, must contain the same information.
†
50/50 Add-Ons and Cash Calendar Add-Ons must be ordered
in conjunction with your HCF Hospital Home Lottery ticket. 50/50
Add-On and Cash Calendar Add-On orders will not be accepted
after your original HCF Hospital Home Lottery ticket order date.
If a ticket order for the HCF Hospital Home Lottery is cancelled,
any and all 50/50 Add-On tickets and Cash Calendar Add-On
tickets associated with that ticket will also be cancelled.
Cardholder’s Name__________________________________________________________________________________ Cardholder’s Signature__________________________________________________________________________________
Card Number:
Expiry Date:
MM
Y Y
Lottery Licence #XXXX