Fill It Up Club 2012 Weekly Drawing Entry

Fill It Up Club 2012 Weekly Drawing Entry

Complete the information below to be entered into our weekly drawing for Filling It Up! Four random prizes will be awarded each week.

* Scout First Name

* Scout Last Name

* Address

* City

* State

* ZIP Code

* Type of Unit

* Unit Number

* Town Where Unit is Located

Parent/Guardian Information

* Parent/Guardian First Name:

* Parent/Guardian Last Name

* Email Address
You will be receiving emails throughout the sale with updates, deadlines & reminders.

* Daytime Phone Number

* What's the Total Retail of this Form?
Example:Add up the total of the order from for all 30 customers and place the answer in the box.

* Electronic Signature
By signing below, I am certifying that my child completed one Take Order form with at least 30 customer orders. I understand that I will furnish a copy of my Take Order form if requested. Yes, I've Filled It Up!

If you have a question, comment, or suggestion, please e-mail: John Fortini