$500 GRAND PRIZE SHOPPING SPREE DRAWING

REGISTER YOUR PURCHASE TO ENTER THE $500 GIFT CARD GRAND PRIZE DRAWING! 

Thank you for supporting local South Side Chicago businesses and registering your purchase.  PLEASE CLICK SUBMIT BUTTON AT THE END TO COMPLETE YOUR ENTRY.

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* 1. Your Contact Info:

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

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

Date

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* 5. What is the total amount on your receipt? (Must exceed $15.00) 

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

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