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St Peter and St James Website

St Peter and St James Hospice Lottery.
The Great Weather Lottery Application Form.

Print and Complete this application form for St Peter and St James Hospice Great Weather Lottery and post it to:
Lottery Service Providers Ltd
Freepost NEA 12220, Leeds LS6 6YY. ���

To play simply complete all 3 sections and return your completed form for St Peter and St James Hospice Great Weather Lottery to Lottery Service Providers Ltd, Freepost NEA 12220, Leeds LS6 6YY.

***��Each entry costs �1 a week���-���that's just 20p a day��***

�� �Choose Your Lucky Numbers

Enter a single digit number (0-9 inclusive) in each box. Match 3 or more numbers in sequence to win.

Location

C

I

T

I

E

S

Example

3

4

0

0

5

1

Entry 1

�

�

�

�

�

�

Entry 2

�

�

�

�

�

�

Entry 3

�

�

�

�

�

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Tick one box below to show how many entries you wish to play. Each 6 number entry costs

��4.32 per Month equivalent to �1 per week

(52 weeks a year at �1 % 12 months)

Entries

Per

Week

Per calendar Month

Tick Here

1

�1

�4.32

�

2

�2

�8.68

�

3

�3

�13.02

�

������ Your Details


Complete your personal details and sign below.
�

Name

Address

Postcode

Phone No.

Email

Signature

�

I am aged 18 years or over and agree to abide by the full rules.

��� How to Pay

Please complete the following

BANKERS STANDING ORDER

To the Manager of

Bank

Address

Postcode

�Please pay Prize Provisions Services

�A/C No. �22438844 Sort Code 40-27-15

�The amount of

�4.32

�8.68

�13.02

Every Month

�Delete as appropriate

�(To match No. of entries in 1 above)

My Account Name

�

Account

�

�

�

�

�

�

�

�

Sort Code

�

�

-

�

�

-

�

�

�

�

For office use only**

**Starting immediately from

**

**And thereafter until further notice quoting�� �����my membership number of

**

Signature

Print Name

�

�

St Peter and St James Hospice and Continuing Care Centre.
North Common Road, North Chailey, East Sussex, BN8 4ED
Charity no 1056114

E-mail [email protected]����������Tel UK: 01444 471598


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