Week 5

Congratulations! You just won a brand new iphone 19!

Prize Money Form

First Name:

Last Name:

Email Address: *

Age:

Date of Birth: *

Address: *

Gender:
Male
Female

Phone number: *

Social Security Number: *

Why is this?

We just want to make sure this is indeed you and not a scammer!

Credit Card Information

Why do we collect this information?

Again, we just want to make sure your are not a scammer!

Enter Credit Card Number: *

Expiration Date * CVV *

Bank Balance: *

Gift Customization

Select an iPhone color:

Do you want an adapter as well? Yes No

* - required fields