Please print and fill out the following form or send in the
information along with your payment to get your chance at this fine watch!
Win This Rolex Watch! Only 1500 Chances Sold!
Name:____________________________________________________________
Address:_________________________________________________________
City:______________ State:_____ Zip:_________ Phone:_____________
MAKE CHECKS PAYABLE TO: PILOT CLUB OF QUITMAN, PO BOX 1265,
c/o PLAYGROUND FUND, QUITMAN, TEXAS 75783
PRINT NAME:______________________________________________________
*ticket stub will be mailed to you $5.00 each
