Millersville Fire Company
P.O. Box 52 - 26 E. Charlotte Street
Millersville, PA 17551

Online Lottery Calendar Order Form
 Please print this form and mail it with your payment 


Name ________________________________                My Special Request number(s)

Address ______________________________                1st Choice** ______________

             _______________________________               2nd Choice** ______________

Phone ________________________________               3rd Choice** ______________

Email ________________________________                4th Choice** ______________

** Choices for calendars cannot be guaranteed.  We will do our best to fulfill your request.

                                                               # of calendar(s) ____ x $25.00 = __________

             Super Size Me !!
             Add $5.00 per month / calendar  =  # of months (s) ____ x $5.00 =  __________             

Please add $1.00 per calendar for postage  - # of calendar(s) ____ x $1.00 = __________

                                                                                           Grand Total $ __________

 

Super Sized Months

-          Please indicate month(s) by name below

-         December is not eligible

(Several months have regular winnings of between $30 and $100, which could be tripled)

List the month(s) below you want to Super Size. January thru November are eligible.

Month ____________    Month _____________  Month _____________

Month _____________  Month _____________  Month _____________

Return to : Millersville Fire Co.
                 C/O Calendar Fund
                 P.O. Box 52
                 Millersville, Pa. 17551-0052

** Calendars will be mailed as soon as possible. **