Digital Entry Verification Form Sweepstakes Digital Entry Verification Number Digital Entry Verification Number * IMPORTANT: You must save your Digital Entry Verification Number in a separate document for your records prior to submitting this form! Name * Name First First Last Last Date of Birth * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Phone * Date of Entry * I understand that I will longer have access to the Digital Verification Number upon submitting this form. * Yes, I understand. CAPTCHA If you are human, leave this field blank. Submit
