St r e e t I m p a c t ~ A m e r i c a R a f f l e [mail form

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Ticket Donations by Check!

Complete the form below to send your donation for raffle tickets by check.

Your gift will directly benefit Street Impact ~ America, a division of Masterpeace Communications. To send by traditional mail, please print and fill out the form below and mail it along with your gift (check) to the address at the bottom of this page.

All gifts are fully deductible for federal income tax purposes to the extent allowed by law. The information provided on this form will be used only by Street Impact ~ America and its agents to process your donation. Click the return buttom to return to Street Impact's web site when the form is completed.

We thank you for your donation!

Raffle Ticket Form for Mailing Checks

*All fields are required!

            Mailing Information . . .

* Full Name:

* Postal Address:

* Street Address:

* City:

* State:

* Postal Code:

* Country:

* Phone - Country Code:

* Phone Number:

* E-mail Address:

            Ticket Information . . .

* Number of Tickets:
Singles:    Books:

    x $20.00                 x $100.00

* Donation Amount:
- (click to total)





Send Donations To:
Street Impact America Raffle            ~                Post Office Box 8877                     ~                    Tyler, Texas 75711
Telephone: 1.903.509.9005                                 Email: raffle@streetimpact.com                                Facimille: 1.903.509.0005
A 501(c)(3) Non-profit Organization                   MasterPeace Communications, Inc.                    All Donations are tax deductible


	© 2011 Street Impact ~ America Raffle!