Subscription Order Form

Subscription Order Form
PLAY BY
Call toll free: 1-800-665-3313 for Subscription Services
ALWAYS IN!
Birthdate
Last Name
q INDIVIDUAL
q GROUP (IN TRUST)
Please check method of payment:
q e*
DD / MM / YYYY
__________________________________________
INDIVIDUAL SUBSCRIBER OR PERSON RESPONSIBLE FOR A GROUP SUBSCRIPTION
q y*
q Cheque
q Money Order
For credit card purchases, we require:
Given Names
__________________________________________
CREDIT CARD # __________________________________________
Address
__________________________________________
EXPIRY DATE
__________________________________________
__________________________________________
SIGNATURE__________________________________________
Province
TOTAL PAYMENT ENCLOSED: $ ______________________________
__________________ Postal Code ____________
Daytime Phone Number ( _____ ) ____________________________
Email Address
__________________________________________
Gift from
__________________________________________
Persons under 18 years of age may not purchase or cash lottery tickets.
Please allow approximately four (4) weeks for processing.
SELECT 7 numbers from 1 to 49
MAIL TO: WCLC, Postal Bag 7777
Stettler, AB T0C 2L0
or FAX TO: (403) 742-7191
*If you wish to pay with your credit card, please confirm with your card provider what,
if any, additional fees may apply for a lottery Subscription purchase. WCLC is not
responsible for any such fees.
CALCULATION OF PAYMENT
1 _____ _____ _____ _____ _____ _____ _____
2 _____ _____ _____ _____ _____ _____ _____
3 _____ _____ _____ _____ _____ _____ _____
4 _____ _____ _____ _____ _____ _____ _____
5 _____ _____ _____ _____ _____ _____ _____
$5 per line selected X ___ lines X q 26 q 52 draws = $ _________
+
q Add ____# of
X $1 X number of draws = $ _________
You may add one EXTRA per line of LOTTO MAX numbers selected
LOTTO MAX Total = $ _________
or q QUICK PICK
SELECT 7 numbers from 1 to 49
CALCULATION OF PAYMENT
1 _____ _____ _____ _____ _____ _____ _____
2 _____ _____ _____ _____ _____ _____ _____
3 _____ _____ _____ _____ _____ _____ _____
4 _____ _____ _____ _____ _____ _____ _____
5 _____ _____ _____ _____ _____ _____ _____
$2 per line selected X ___ lines X q 26 q 52 draws = $ _________
+
q Add ____# of
X $1 X number of draws = $ _________
You may add one EXTRA per line of WESTERN MAX numbers selected
WESTERN MAX Total = $ _________
or q QUICK PICK
SELECT 6 numbers from 1 to 49
1 _____ _____ _____ _____ _____ _____
2 _____ _____ _____ _____ _____ _____
3 _____ _____ _____ _____ _____ _____
4 _____ _____ _____ _____ _____ _____
5 _____ _____ _____ _____ _____ _____
CALCULATION OF PAYMENT
$2 per line selected X ___ lines X q 26 q 52 q 104 draws = $ _________
+
q Add ____# of
X $1 X number of draws = $ _________
You may add one EXTRA per line of LOTTO 6/49 numbers selected
LOTTO 6/49 Total = $ _________
6 _____ _____ _____ _____ _____ _____
or q QUICK PICK
SELECT 6 numbers from 1 to 49
1 _____ _____ _____ _____ _____ _____
2 _____ _____ _____ _____ _____ _____
3 _____ _____ _____ _____ _____ _____
4 _____ _____ _____ _____ _____ _____
5 _____ _____ _____ _____ _____ _____
CALCULATION OF PAYMENT
$1 per line selected X ___ lines X q 26 q 52 q 104 draws = $ _________
+
q Add ____# of
X $1 X number of draws = $ _________
You may add one EXTRA per line of WESTERN 649 numbers selected
WESTERN 649 Total = $ _________
or q QUICK PICK
Incorrectly completed Subscription order forms will be returned. Note: The Corporation cannot ensure the first draw date. Please allow approximately 4-6 weeks for processing. For Subscription information call 1-800-665-3313.
Subscription is available only in Alberta, Saskatchewan, Manitoba, Northwest Territories, Yukon Territory and Nunavut. Persons under 18 years of age may not purchase or cash lottery tickets. Proof of age may be required.
IMPORTANT: CHECK SELECTIONS IMMEDIATELY FOR ACCURACY UPON RECEIPT OF SUBSCRIPTION CERTIFICATE. Only Selections recorded on the applicable computer system of Interprovincial Lottery Corporation (ILC) or Western Canada
Lottery Corporation (WCLC), and appearing on the Subscription Certificate issued pursuant to this order form, are eligible to participate in draws. WCLC cannot ensure the first draw date and is not liable for any loss suffered by a Subscriber
as a result of the failure or any delay in recording the Subscriber’s ticket numbers into the computer system. LOTTO MAX™, LOTTO 6/49, WESTERN MAX, WESTERN 649, and EXTRA are governed by the applicable Rules and Regulations
Respecting Lotteries and Lottery Tickets of ILC and the Rules and Regulations Respecting Lotteries and Gaming of WCLC and Game Conditions WHICH INCLUDE LIMITATIONS OF LIABILITY and are available from WCLC upon request.