Purchase Raffle

Drawing, Tuesday, January 8, 2018

Choose one of the following options*

Full Name*

First NameLast Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area CodePhone Number

E-mail*

Reffered By

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Total

$0.00

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STUFF OUR LAWYERS TOLD US TO TELL YOU: By entering this raffle, participant (and participant's parent/legal guardian) waives all rights to claim punitive, incidental and consequential damages, attorneys' fees or any damages other than actual out-of pocket costs incurred to enter. Winners will assume and be responsible for any licensing, registration, and other fees, and any local, state and federal taxes, including without limitation any applicable sales, use, luxury, income and special taxes. The decision of Chabad of West Orange shall be final on all matters concerning this raffle. By entering the raffle, the participant agrees that his/her name and image may be used for promotional purposes. All participants must be 18 years of age or older. Thank you for supporting a worthy cause. Void where prohibited by law. No purchase necessary: To submit an entry without a contribution please record your complete name, address, telephone number and email address on a 3" x 5" index card and mail to: Chabad Chayil, 2601 NE 211 Terr, Miami, FL 33180

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