Prize Claim Form

This Form is for Winners Only

Prize Claim Form

I understand that 98.3 WCCQ/Alpha is not responsible for any lost, stolen, or damaged prizes which are sent to me by mail. I am aware that 98.3 WCCQ/Alpha a will not mail any prizes that are valued above $50.00, bulk prizes such as cd’s and DVD’s that have been won. 98.3 WCCQ/Alpha will not be required to replace any prizes that have been lost, stolen, damaged, arrive late or compensate the listener for said items. – Contestants are not eligible to win multiple prizes within 30 days and if prize is valued over $500.00, contestants are not eligible to win for 60 days. – Signing this waiver does not guarantee 98.3 WCCQ/Alpha will mail your prize and is subject to verification of prize won. – 98.3 WCCQ/Alpha will hold prizes for a maximum of 30 days; prizes not claimed within 30 days will be forfeited and become property of 98.3 WCCQ/Alpha.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Prize Won*
I agree to the above terms and conditions:*
- Yes
- No