| Shipping Address: Name : ___________________________________________________ Street addres :______________________________________________ City: _________________________________________________ State: _________________ Zip: ____________ Phone: ( ____ ) ________ Mail form to: Alfred Ricks, 2142 Riverside Drive, West Columbia, TX 77486 |
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| Quantity | Ticket # | Item Description | Single Ticket Price |
Multi- Ticket # / Price |
Total | ||||||||||
| ________ | 01 | LONE STAR MILLIONS | $450 | 5 / $2,700 | ________ | ||||||||||
| ________ | 02A | TEXAS MATCH UP (ISSUE #1) TEXAS FLAG | $250 | 5 / $1,500 | ________ | ||||||||||
| ________ | 02B | TEXAS MATCH UP (REISSUE #2) 3 STARS | $250 | 5 / $1,500 | ________ | ||||||||||
| ________ | 03 | TEXAS TWO STEP | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 05 | TOUCHDOWN (#1) | $40 | 5 / $240 | ________ | ||||||||||
| ________ | 06 | LUCKY 7 (#1) | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 07 | STOCKING STUFFER | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 09 | TEXAS CASH ROUNDUP | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 10 | FIESTA (#1) (4 TICKET SET) | 4 / $240 | ________ | |||||||||||
| ________ | 11 | GRAND SLAM | $25 | 5 / $150 | ________ | ||||||||||
| ________ | 12 | CACTU$ CA$H (ISSUE #1) | $25 | 5 / $150 | ________ | ||||||||||
| ________ | 15 | TEX TAC DOUGH | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 16 | TEXAS GOLD | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 17 | JOKER'S WILD (#1) | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 18 | CASH CELEBRATION (#1) | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 19 | TEXAS HOT CASH (4 TICKET SET) | 4 / $150 | ________ | |||||||||||
| ________ | 20 | ARMADILLO DOLLARS | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 21 | WIN FOR LIFE | $40 | 5 / $240 | ________ | ||||||||||
| ________ | 22 | HOLIDAY CASH (4 TICKET SET) | 4 / $150 | ________ | |||||||||||
| ________ | 23 | BEAT THE DEALER (#1) | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 24 | THREE ACROSS TEXAS | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 25 | TEXAS BONUS CARD (ISSUE#1) | $50 | 5 / $300 | ________ | ||||||||||
| ________ | 26 | TEXAS TORNADOUGH | $15 | 5 / $90 | ________ | ||||||||||
| ________ | 27 | BLUEBONNET BUCK$ | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 28 | THE $100,000 GAME | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 29 | MOOLAH MANIA | $15 | 5 / $90 | ________ | ||||||||||
| ________ | 30 | CACTU$ CA$H (REISSUE #2) | $25 | 5 / $150 | ________ | ||||||||||
| ________ | 31 | INSTANT MILLION | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 32 | BLACKJACK | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 34 | TEXAS HEAT WAVE | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 35 | BOOT SCOOTIN' BUCK$ | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 37 | TWO FOR THE MONEY | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 38 | FOOTBALL FEVER | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 39 | DOUBLE DOUBLER (ISSUE #1) | $30 | 5 / $180 | ________ | ||||||||||
| ________ | 40 | HOLIDAY DOUGH (4 TICKET SET) | 4 / $150 | ________ | |||||||||||
| ________ | 41 | LONGHORN LOOT | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 42 | DEUCES WILD! | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 44 | HOG MANIA (ISSUE #1) | $25 | 5 / $150 | ________ | ||||||||||
| ________ | 45 | TEXAS HIGH ROLLER | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 46 | CASH REWARD (4 TICKET SET) | 4 / $150 | ________ | |||||||||||
| ________ | 47 | TEXAS HIGH CARD | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 48 | WEEKLY GRAND (ISSUE #1) | $50 | 5 / $300 | ________ | ||||||||||
| ________ | 49 | BONUS 7'S | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 50 | TEXAS TREASURE HUNT | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 51 | BEAT THE DEALER (#2) | $20 | 5 / $120 | ________ | ||||||||||
| ________ | 52 | RED HOT CASH | $30 | $180 | ________ | ||||||||||
| ________ | 53 | FIRST DOWN (ISSUE #1) | $25 | 5 / $150 | ________ | ||||||||||
| ________ | 54 | JOKER'S WILD (#2) | $20 | 5 / $120 | ________ | ||||||||||
| ________ | SP01 | Limited edition collector's set of Texas
lottery tickets. Over two hundred Texas Lottery Ticket Games. (Limited Number of Sets Available) |
$9,000 | ________ | |||||||||||
| Merchandise Total | ________ | ||||||||||||||
| Shipping & Handling: ____ UPS ($8) ____ Federal Express 2nd Day ($13) ____ U.S. Postal Service ($10) |
________ | ||||||||||||||
| Texas Residents Sales Tax (8.25%) |
________ | ||||||||||||||
| ORDER TOTAL | ________ | ||||||||||||||
| PLEASE READ CAREFULLY! Specific tickets of a multi ticket group cannot be selected. To obtain a complete set of multi tickets, you must order the total number of multiple designs in that set. All lottery tickets are in unscratched mint conditon, but there is no guarantee that the tickets will be totally free of all defects. All lottery tickets sold are expired and cannot be redeemed for scratch off winnings. We do not sell unexpired lottery tickets. All prices are subject to change without notice. Quantities are limited. We do not ship to APO/FPO. We can ship to PO Boxes only by U.S. Postal Service. No COD orders. Multi-tickets are a complete set of unseparated tickets of a multiple design lottery ticket or five (5) unseparated tickets of a single design lottery ticket. Current multiple design lottery tickets with number of designs in parenthesis: Fiesta (4 tickets); Texas Treasures (12 tickets); Texas Hot Cash (4 tickets); Holiday Cash (4 tickets); Holiday Dough/Mint/Cheer/Bucks (4 tickets); Cash Reward (4 tickets). Texas residents must pay tax on the total of: merchandise charges plus shipping and handling charges. Make payment by check (allow 10 days to clear) or money order to: Alfred Ricks, 2142 Riverside Drive, West Columbia, TX 77486 If you would like to pay by credit card, you must complete the order form information below. WE ARE NOT ASSOCIATED WITH THE TEXAS LOTTERY COMMISSION OR THE STATE OF TEXAS. |
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Circle payment method: Personal Check / Cashier's Check / Money Order / Cash / Credit Card
Note: Credit Card Billing and Shipping address must be same.
Date: _________________________
Name : ___________________________________________________
Billing Address :______________________________________________
City: _________________________________________________
State: _________________ Zip: ____________
Phone: (_____) __________________________
Email: _________________________________
| Circle Your Card Type: | VISA | MASTERCARD | AMERICAN EXPRESS |
Name On Card: ________________________________________________
Card Account Number: _____________________________________________
Card Expiration Date (mm/dd/yyyy): ___________________________________
Mail form to:
Starr Vision Productions, Inc.,
2142 Riverside Drive,
West Columbia, TX 77486
http://www.healthcallin.com
Credit Card Phone Orders: (800) 283-7582
You Can Fax This Order Form To: (979) 345-2003