NORCAL Golden Retriever Rescue
2001 Auction & Wine Tasting

"Golden Circle" Raffle Ticket Order Form

Ticket Buyer Information
First Name  
Last Name  
Title  
Address  
City  
State  
Zip Code  
County  
Country  
Home Phone  
Email  
Company  
Occupation  
Ticket Order Information
Category Quantity Price
Single Tickets   $40.00
Group of 3 Tickets   $100.00
Group of 8 Tickets   $200.00
If paying by check: Please make check payable to NGRR
If paying by credit card: Please provide the following information:
  Visa    MasterCard
Card Number 
Expiration Date 
Card Holder's Name as it appears on the credit card :
(please print)

    Signature: ________________________________________

Please print this form and mail it to:
NORCAL Golden Retriever Rescue
405 El Camino Real, Suite 420
Menlo Park, CA 94025-5240

Tickets will be sent by return mail.

Contact Information
If you have any questions, please call:
Jack Agresti
  (650) 851-7604  e-mail: jjagresti@aol.com
Dave Ball  (650) 917-1387  e-mail: kball9@earthlink.net

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