Complete the following application form for the

Hamelin Trust Lottery

 

To play simply complete all 3 sections and return your completed form to Lottery Service Providers Ltd, FREEPOST NEA12220, LEEDS LS6 2YY. 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

 

 

 

 

 

 

Tick one box below to show how many entries you wish to play. Each 6 number entry costs £4.34 for 1 month (equal to just 20p a day).

Entries

Cost for 1 month

Tick Here

1

£4.34

 

2

£8.68

 

3

£13.02

 

Your Details

Complete your personal details and sign below.

Name

Address

Postcode

Signature

 

How to Pay  (You can pay by Cheque or Postal Order, or you can pay by Bank Standing Order)

 

To pay by Cheque or Postal Order, make cheques payable to Prize Provision Services Ltd

£13 per line for 13 Weeks
£26 per line for 26 Weeks
£52 per line for 52 Weeks

 

To Pay by BANKERS STANDING ORDER, please complete the following:

to the Manager of:

Bank

Address

Postcode

 

Please pay Prize Provision Services Ltd A/C No. 22438844 Sort Code 40-27-15 the amount of:

£4.34

£8.68

£13.02

Monthly

 

My Account Name

Account

 

 

 

 

 

 

 

 

Sort Code

 

 

-

 

 

-

 

 

Signature

Print Name

Start from (for office use only)

and thereafter until further notice quoting my membership number of

for office use only