Eden Family Raffle Ticket Order Form

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Please fill out the form below to order your Eden Family Raffle Tickets.

If you are paying by credit card, an Eden representative will contact you for payment.

If paying by check, please send payment with your completed ticket stubs to
Hinkle Prior & Fischer, 2651 Main Street, Lawrenceville, NJ 08648.

Ticket stubs must be received by June 21st to be entered into the raffle.

Email *

Name *

I am an: *

Mailing Address *

City *

State *

Zip Code *

Phone Number *

How would you like to pay? *

Credit Card

Check - Make payable to Eden Autism Services

N/A - I will be selling the tickets

Number of Tickets Requested ($5 per ticket) *

I would like to request more than 20 tickets. Please send me the following number of tickets. (Must be more than 20)

A copy of your responses will be emailed to the address you provided.

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