ENTRY FORM

Please fill out the information below and mail a self addressed stamped envelope to 904 Bethel Circle, Waunakee, WI 53597 for your chance to win up to $250 with a FREE pull tab card.

No purchase necessary. Limit one monthly per household.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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