Personal Details

Unite Branch

Title (required)
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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 Unite regarding the Unite Lottery - (tick all that apply)

Direct mailPhone callText messageEmail

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

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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 'Unite Lottery'.

I would like the kick-off offer. Tick this box to get two months free. Your first payment will be £44 per line, followed by regular monthly payments of £4.34 per line in a years time. Unite will pay the £8 difference.
YesNo

Bank Details:

Account Holders Name

Bank Name (required)

Branch (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.

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