To provide a betting ticket application form enhancing the degree of freedoms of purchasing a betting ticket, having a simple application method and small possibility of bringing about a mistake and facilitating grasping of betting contents.

A purchasing application form 10 of a combination betting ticket comprises a plurality of areas 17 each for sequentially designating a second side by fixing a first place side, a plurality of areas 16 each for sequentially designating the first place side by fixing the second place side, a plurality of areas 18 each for designating a fixed number of the first place side or the second place side, a plurality of areas 21 each for individually designating a combination number as a pair with the fixed number, a plurality of areas 22 each for designating a purchasing amount of the combination number and a plurality of areas 23 each for designating canceling of purchasing.