Form

Blasting Through P.A.D. Raffle Ticket Purchase

Raffle 1: Cooler filled with Wagyu beef

Raffle 2: Shotgun (Beretta Silver Pigeon Field Over & Under 20 gauge OR Benelli Super Black Eagle 3 Semi-Automatic 12 gauge)

*First name:

*Last name:

*Email address:

*What would you like to try to win?

Total cost:

0.00

*Card Type:

*Credit Card Number:

*Expiration Month:

*Expiration Year:

*First Name:

*Last Name:

*Billing Address:

*City:

*State:

*Zip:

*Phone:

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