Lucky Numbers Application Form

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Your Name *

Address, including postcode *

Email *

Telephone number *

Please state how many Numbers you would like to purchase per quarter. £3 per Number. Every Number purchased will be entered into each quarterly draw. *

*I confirm I have set up a Standing Order payable on the 1st day of the third month of each quarter (December, March, June and September) to cover the number of tickets purchased OR *I will make my payment each quarter directly to Account No 76076059 Sort Code 60-17-24, using LN and my initial and surname as the payment reference: e.g. LN A SMITH *

I agree

Required

I understand that if no payment is received by the due date then any Numbers previously purchased will not be entered in the draw. *

I agree

Required

I confirm that I am 16 years of age or over *

Yes

Required

I agree that the above details can be held securely and will only be used for the purposes of the Lucky Numbers draw *

I agree

Required

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