Fundraiser Payment Form

Use this form to purchase tickets to a Variety SA fundraiser or fundraising initiative

First Name*
Last Name*
Mobile Number
Name of fundraiser or fundraising initiative*
eg. Bash Car 123 Raffle or Bash Car 01 Quiz Night
Car / Bike Number or Team Name*
If the fundraiser is for something other than a Motoring entrant please put N/A
Number of tickets*
Total payment amount?*

eg. 2x raffle tickets @ $10 = $20
Do you wish to purchase tickets in a company / organisation name?*
- Yes
- No
Name of company / organisation*
Extra comments or information about your purchase
How did you hear about this fundraiser?*
I am happy to receive communication materials from Variety SA regarding upcoming news and events*
- Yes
- No
Payment
Total
$ 0.00
Email Address for Receipt*
Billing Address (optional)
Street Address Address Line 2 City State Postcode
If you have any questions, please don't hesitate to contact us on (08) 8293 8744 or [email protected]
Pay now for your Variety Fundraiser tickets.
Credit Card*
American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
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South Australian Charity Number CCP2924