Title (required)
---MrMrsMissMs

First Name (required)

Last Name (required)

Date Of Birth (dd/mm/yyyy) (required)

You must be 16 or over to enter. By ticking this box you are confirming you are 16 or over. It is an offence to enter a lottery under the age of 16

Address 1 (required)

Address 2

Town (required)

County (required)

Postcode (required)

Landline Number

Mobile Number

Your Email (required)

Allow contact from Lincoln City FC with news, information and special offers we think you’ll be interested in - (tick all that apply)

Direct mailPhone callText messageEmail

Allow contact from Prize Provision Services - (tick all that apply)

Direct mailPhone callText messageEmail

Entry Information:

Number Of Lines:

12345

The first monthly payment will be £6.34 per line, followed by regular monthly payments of £4.34 per line.
Your first monthly payment will be £2 higher per line than your regular payment to avoid missing a draw in a 5 week month. This will be held on your account balance and used in future draws.
This will appear on your bank statement as 'Prize Provision Services'.

Bank Details:

Account Holders Name

Bank Name (required)

Sort Code (required)

Account Number (required)

Please confirm that the account is in your name and you are the only signatory required to authorise this direct debit. If this is not the case please download and complete a paper mandate below.

Dual Signatories only - click to download a paper mandate.

Please confirm you have read the terms & conditions

By using this form you agree with the storage and handling of your data by this website.

Promo Code