GRAND PRIZE DRAWING

REGISTER YOUR PURCHASE TO ENTER THE GRAND PRIZE DRAWING! Thank you for supporting Small Business Saturday and registering your purchase.  PLEASE CLICK SUBMIT BUTTON AT THE END TO COMPLETE YOUR ENTRY.

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* 1. Enter 4-Digit Ticket Code

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* 2. Your Contact Info:

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* 4. How long have you been a customer of this small business?

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* 5. What is the date of purchase on your receipt?

Date of Purchase

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* 6. What is the the total amount of  your receipt?

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* 7. Did your purchase include any of the following? (choose all that apply).

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