order form
Please place your order before December 14, 2007
Four convenient ways to place your order
Mail
Akiva Hebrew Day School
21100 W. 12 Mlle Rd.
Southfield, MI 48076
Phone
248.386.1625
Daytime
Fax
248.386.1632
Online
www.akivak12.org
click on auction link
Please mark the tickets you wish to purchase
Admission tickets: $36 per person
Raft e: 1 for $100, 3 for $250
# Tickets = $
# Tickets = $
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Discount coupon packages (only available
before December 14, 2007)
$300 buys coupons worth $500*
$500 buys coupons worth $1,000*
$1,000 buys coupons worth $2,000*
$1,500 buys coupons worth $3,000*
$2,000 buys coupons worth $4,000*
All coupon packages include two free admission tickets.
Coupon packages are not valid for use in the $10,000 raffle drawing.
$100 selections
$75 selections
$50 selections
$35 selections
$20 selections
$10 selections
# Tickets = $
# Tickets = $
# Tickets = $
# Tickets = $
# Tickets = $
# Tickets = $
Total Amount $
Please mark your selections carefully
$100 ❑ 1
$75 ❑ 2 ❑ 3 ❑ 4 ❑ 5 ❑ 6
$50 ❑ 7 ❑ 8 ❑ 9 c] 10 ❑ 11 ❑ 12 o 13:114
$35 t: 15 0 16 ❑ 17 0 18 ❑ 19 ❑ 20 ❑ 21 ID 22 ❑ 23 ❑ 24
❑ 25 ❑ 26 ❑ 27
$20 ❑ 28 ID 29 ❑ 30 o 31 ❑ 32 ❑ 33 ❑ 34 ❑ 35 ❑ 36 ❑ 37
❑ 38 ❑ 39 ❑ 40 ❑ 41
$10 ❑ 42 ❑ 43 ❑ 44 ❑ 45 ❑ 46 ❑ 47 ❑ 48
City / State / ZIP
Individual coupon selections
❑ Visa ❑ M C ❑ Am Ex
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