Prize Claim

NAME______________________________________________________

STREET ADDRESS____________________________________________

CITY_______________________________________________________

STATE______________________________________________________

PHONE #____________________________________________________

CIRCLE PRIZE REQUESTED

SONY PSP - 60,000,000                                                     iPhone - 60,000,000

DIGITAL CAMERA - 30,000,000                                      MP4 PLAYER - 16,000,000

2 MOVIE TICKETS (Gift Certificate) - 6,000,000

Enclose claim form and tickets and mail to: