Application form   

Title.........................    Initials........................ Surname..........................................

Address....................................................................................................................

.................................................................................................................................

Post Code.........................................         Telephone..............................................

NOTE: YOU MUST BE OVER 16 YRS OLD TO PLAY

Cheque Payment

I wish to buy .......... chance(s) each week for 13/26/52 weeks and remit a cheque for £ ................
made Payable to 'TC Lottery Ltd'

To ........................................................................ Bank plc

Branch ...............................................................

Sort Code .............................      Account Number .................................................

Account Name ....................................................

Commencing (date)............................................................. the sum of:

......... chance(s) @ £  4 = £ ........ & thereafter every  4 weeks

..........chance(s) @ £13 = £ ........ & thereafter every 13 weeks

..........chance(s) @ £26 = £ ........ & thereafter every 26 weeks

..........chance(s) @ £52 = £ ........ & thereafter every 52 weeks        until further notice.

Signed............................................       Dated ................................                                                        

Tuckwell CHASE Lottery Ltd, Freepost (SCE 6595), Waverley Lane, Farnham, Surrey, GU9 8BL.