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Get and Sign Com2ndchance 2019-2022 Form
Retailer?
No
PRIZE INFORMATION
PRIZE NAME:
DRAWING NAME:
TICKET ID/
ENTRY CODE:
DRAWING ID
(IF APPLICABLE):
PROVIDING THE FOLLOWING INFORMATION IS VOLUNTARY
Which of the following do you consider yourself to be:
Annual household income (Check one)
African American
Hispanic
Under $20,000
$50,000 to $75,000
Asian
White
$20,000 to $35,000
Over $75,000
$35,000 to $50,000
Number of people in household
Other (specify)
Education (Check one)
Gender (Check one)
Occupation (Check all...
Show details
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