test form page

Name*

First Last

Phone #*

Email:*

Enter Email Confirm Email

Already have a Big Bucks Number?*

If you have a big bucks number, even if you haven't played recently, it is your number for life and you can begin to play that number anytime. Please call 902-895-4562 to confirm your big bucks number if you have one, before completing this form.

Mailing Address*

Street Address Address Line 2 City Must be NS Resident and 19+ Postal Code

Ticket Delivery Method*

The ticket, with big bucks number, will be provided to you. It is your responsibility to play the correct number and to follow all the Big Bucks House Rules.

Number of Weeks you are playing your new Big Bucks Number for:*

52 weeks will enter you into the weekly draws for the entire year. We will send you an email reminder when you are due to renew your big bucks number.

Number of Big Bucks Numbers you are Extending Play for*

Please enter a number from 1 to 5.

For 1 Big Bucks Number, enter 1, for 2 Big Bucks Numbers, enter 2m up to 5 Numbers maximum per form.

First Big Bucks Number:*

You are responsible for playing the correct number. The big bucks number you enter here will be the number played.

Nubmer of Weeks for First Big Bucks Number:*

Second Big Bucks Number:*

You are responsible for playing the correct number.

Number of Weeks for Second Big Bucks Number:*

Third Big Bucks Number:*

You are responsible for playing the correct number.

Number of Weeks for Third Bucks Number:*

Fourth Big Bucks Number:*

You are responsible for playing the correct number.

Number of Weeks for Fourth Big Bucks Number:*

Fifth Big Bucks Number:*

You are responsible for playing the correct number.

Number of Weeks for Fifth Big Bucks Number:*

Add a Donation to Big Brothers Big Sisters of Colchester*

In wake of COVID-19, our services have never been so important. All donations received will support matching children and youth in our communities with Mentors so that they can reach their full potential through this time of added household stress and adversity.

Total to be Charged to Credit Card

$ 0.00 CAD

You must enter this amount on next page (payment)

Big Bucks House Rules*

I have read and understand all the Big Bucks House Rules

Big Bucks Online Form