DMH Lottery Renewal

Lottery Number
(if known)

Title*

Initial*

Last Name*

Address*

Town/City*

County

Postcode*

Telephone*

Mobile

Email*

Date of Birth*

DD/MM/YYYY
All lottery players must be aged 16 years or over.

Choose your payment amount

For 1 weekly lottery number

£10 every 10 weeks

£26 every 26 weeks

£52 every year

For 2 weekly lottery numbers

£20 every 10 weeks

£52 every 26 weeks

£104 every year

For 3 weekly lottery numbers

£30 every 10 weeks

£78 every 26 weeks

£156 every year

For 4 weekly lottery numbers

£40 every 10 weeks

£104 every 26 weeks

£208 every year

Automatic Renewal

I authorise you to take the chosen regular payment each time my lottery credit is due to expire