Ticket Order Form
Annual "Win a Classic" Raffle


Print and Mail This Form To:
Powell County Museum & Arts Foundation
1106 Main Street • Deer Lodge, MT 59722 • 406-846-3111

Tickets: $5.00 each • 5 for $20.00 • 30 for $100.00


Name_____________________________________________________________________


Phone Number (_____) ______________________________

Address____________________________________________________________________


City________________________________State__________________ Zip_____________

 

Ticket Quantity:

__1 Ticket - $5

__5 Tickets - $20

__30 Tickets - $100

Method Of Payment:

__Check

__ Money Order

__Credit Card

Credit Card Info:

__MasterCard

__Visa

__American Express

Card Number:_____________________________________________

Signature ___________________________________________

Exp. Date:_________