Golf Cart Raffle

Bintelli Beyond

Street Legal Package
Speed up to 25mph
Range up to 30-35 miles
Electric Motor, 5kw, 6.7hp
US Battery, on board charger
800 lb max load
Bluetooth capability
3 year Ltd warranty
LED Lighting

Tickets: $50 each – Drawing 11/9/24
Do not need to be present to win.

Fair Market Value = $13,200
Tax exemption #ORG0002736

MCH Employees Only – Payroll Deduction

"*" indicates required fields

Name*

First Middle Last

Employee Number*

Work Phone*

Home/Cell Phone*

Work Email*

Address*

Street Address City State ZIP Code

Number of Tickets*

Please enter a number greater than or equal to 1.

Total*

Payroll Deduction Full Payment*

The full payment deduction will occur on your next pay period.

Pay in full next pay period

Payroll Deduction Full or Split Payment*

You may choose to pay in full or split your payment between two pay periods. The first deduction will occur on your next pay period.

Pay in full next pay period

Split between two pay periods (2 or more tickets only)

Authorization for Payroll Deduction*

I hereby authorize the Accounting/Payroll department to deduct the total amount indicated above through payroll deduction. I also understand and agree that in the event my employment with Med Center Health (and/or its affiliated corporations) is terminated before this obligation is satisfied, Med Center Health (and/or its affiliated corporations) may deduct any or all amounts in excess of Federal Hourly Minimum Wage from my final paycheck as consideration for payment on this account and that I will remain responsible for entire balance which will be immediately due and owing. Selecting “I Agree” below is your electronic signature to this agreement.

I agree

CAPTCHA

This field is for validation purposes and should be left unchanged.