= LIBRARY

BRCHIVES

SELLING ORGANIZATION APPLICATION

DATE

NAME OF ORGANIZATION
MAILING ADDRESS FOR
LOTTERY CORRESPONDENCE

TICKET CHAIRMAN
Name Address
HOME TELEPHONE BUSINESS

NUMBER OF MEMBERS
OFFICERS OF THE ORGANIZATION:

 

Name Title Address Phone

 

Name Title Address | Phone

 

ORGANIZATION'S BANK
Name Account Number

 

Address

 

I HEREBY AGREE TO ACCOUNT FOR ALL TICKETS DELIVERED TO ME WHEN REQUESTED AND IN
ANY EVENT WILL HAVE ALL STUBS, MONEY AND ANY UNSOLD TICKETS RETURNED TO THE LOTTERY
OFFICE NOT LATER THAN AUGUST 3lst.,1975.

 

Ticket Chairman Signature

eS ES mE Rn SR 8 Re ES ET Se SRN LS SER RE AE AE SEE OE OTN AEE SORE FE TE SA ASE ah ALY 1 ON ROOT HANES
OUR ORGANIZATION AGREES TO ABIDE BY THE PROVISIONS OF THE GREENPEACE FOUNDATION
LOTTERY. PROCEEDS WILL BE USED FOR

 

WE WILL ACCOUNT FOR ALL TICKETS DELIVERED TO OUR ORGANIZATION AS FOLLOWS:
IF 11 TICKETS SOLD IN A BOOK, BY REMITTING $20.00 LESS SALES COMMISSION

OF $2.00 FOR EACH COMPLETED BOOK SOLD, PLUS 11 COMPLETED TICKET STUBS. IF
LESS THAN 11 TICKETS SOLD IN A BOOK, BY REMITTING $2.00 PER TICKET SOLD AND
COMPLETED TICKET STUBS PLUS ALL UNSOLD TICKETS.

 

 

Witness : Authorized official - Title

 

 

OFFICE USE

CLASSIFICATION: © RELIGIOUS C) CHARITABLE O SERVICE OC COMMUNITY
O SPORTS O) OTHER

' REFERENCES CHECKED BY

 

 

 

 

 

PROJECT NUMBER

 

APPROVED BY

 

Lottery Marketing Manager