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Lottery Licence Fee

Invoice

Town of LaSalle
Council Services Department
5950 Malden Road
LaSalle, ON, N9H 1S4

First Name

Last Name

Name of Organization

Email (a copy of this transaction will be e-mailed to you)

Invoice Amount ($)

Additional Fee: Please note that a 1.75% service charge will be applied your credit card.

Questions: If you have any questions or require assistance, please contact Council Services at 519-969-7770 Ext 1234.

Privacy Statement: Personal Information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of issuing a lottery licence. Questions about the collection of this information should be directed to the Director of Council Services/Clerk, Town of LaSalle, 5950 Malden Road, LaSalle, ON, N9H 1S4. Telephone: 519-969-7770

Lottery Licence Fee

Invoice

Town of LaSalleCouncil Services Department5950 Malden RoadLaSalle, ON, N9H 1S4

Additional Fee: Please note that a 1.75% service charge will be applied your credit card.

Questions: If you have any questions or require assistance, please contact Council Services at 519-969-7770 Ext 1234.

Town of LaSalle
Council Services Department
5950 Malden Road
LaSalle, ON, N9H 1S4