Complete the following application form for The Great Wells Weather Lottery
To play simply complete all three sections and return your completed form to us at Lottery Service Providers Ltd, FREEPOST, NEA12220, Leeds, LS6 2YY. Each entry costs £1.00 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.
Your Details
Name
Location C I T I E S
Example 3 4 0 0 5 1
Entry 1
Entry 2
Entry 3
Address
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 20p a day) Postcode
Entries Cost for 1 month Tick here
1 £4.34
2 £8.68
3 £13.02
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.
£13.00 per line for 13 weeks
£26.00 per line for 26 weeks
£52.00 per line for 52 weeks
To pay by Bankers Standing Order, please complete the following:
To the Manager of
Bank My Account Name
Address
Account
Sort code

-

-
Signature
Print Name
Start from (for office use only)
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 and thereafter until further notice quoting my membership no of
(for office use only)

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