Charity Raffle Drawing

• As a manufacturer of electronic, handheld bingo computers, Applied Concepts, Inc. believes in supporting the many charities that use the game of bingo as a fundraiser. We are pleased to offer each organization the chance to win $100.00 in our monthly drawing held at the end of each month.
• The winning organization will be notified and the results of each monthly drawing will be posted to the website.
• No purchase is necessary for your organization to win the monthly drawing. However, each charity must re-enter their name each month to be eligible for the monthly drawing, since all prior month's entries will be discarded. Limit one entry per charity each month.
• Please complete the form below, fields marked with an * are required.
  
  
  Organization Name : *
  
          *Contact Name : *
  
                 *Telephone:
                                          ### - ### - ####
                          *Email:

            Street Address:
  
                                City:
  
                             State:
  
                      Zip Code:
  
          Date Submitted:  
  
                                             Please be patent while the form processes your information.