Lucky Lotto enrolment form

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Please use this form to enrol to the Norris Bank PTAs Lucky Lotto

How Many Numbers would you like to purchase? *

I wish to pay £2 per number per month via standing order *

Yes

Required

I wish to pay annually at £24 per number by … *

Standing order

Bank transfer

I prefer to pay monthly

Required

What is your First Name and Surname? *

Please provide your telephone number? *

Please provide your address *

Please provide your email address *

Please confirm you are over the age of 18 and confirm your Date of birth *

Please note that your reference to use, bank details and standing order form will be emailed to you upon completion of this form. *

I have read and understand

Required

Please read and Agree …. we no longer accept cash payments for the Lucky Lotto. We can only currently accept bank transfers or standing orders

I agree

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