Purchase & Entry Form

Sprint for Sight's
Sunshine State Home Raffle
Giving the gift of sight to children in need.

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Purchase & Entry Form

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (1-800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.
Click Here for an image of the compliance letter from the State of Florida. CH27620

Call 386-492-8473 to Order by Phone!

Raffle Ticket Purchase and Entry Form: Fill in the information below to order your Sunshine State Home Raffle Ticket:

Raffle Ticket Entry

Please complete the form below. All fields required. Entry will be voided if form is not complete!

First Name:
Last Name:
Age:	Must be 18 years or older
Address Street 1:
Address Street 2:
City:
State:
Zip Code:	(5 digits)
Daytime Phone:
Evening Phone:
Card Type:	American Express
	MasterCard
	Visa
Card Number:
Expiration Date:
Number of Tickets to Purchase:
Email: