Quilt Raffle

If you would like to enter a raffle for the Women of Wea Quilt please complete the form below. Please note that if you pay for this with a credit card there is a 3% convenience fee. If you pay for it with your bank account information there is NO convenience fee.
Quilt Raffle Form
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED
  
  Please fill out this field. Please enter a phone number.
- Raffle Price per Ticket REQUIRED
  A convenience fee is required and different depending on your payment type. How are you paying for this - Electronic Check or Credit Card?
  Please fill out this field.
- Number of Raffle Tickets Purchasing REQUIRED Please fill out this field. Please enter an integer (number).
Total:

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