WRXQ - WRXQ Prize Claim Form

WRXQ Prize Claim Form
I understand that 100.7 WRXQ/NextMedia is not responsible for any lost, stolen, or damaged prizes which are sent to me by mail. I am aware that 100.7 WRXQ/NextMedia will not mail any prizes that are valued above $50.00, bulk prizes such as CDs and DVDs that have been won. 100.7 WRXQ/NextMedia 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 the prize is valued over $500.00, contestants are not eligible to win for 60 days. - Completing and submitting this waiver does not guarantee you will receive your prize automatically. It is subject to verification of prize won by the promotions department of 100.7 WRXQ/NextMedia. - 100.7 WRXQ/NextMedia will hold prizes for a maximum of 30 days; prizes not claimed within 30 days will be forfeited and become property of 100.7 WRXQ/NextMedia.


* First Name * Last Name * Street Address * City * State * Zip Code * Telephone Number * E-Mail Address * Prize You Won on 100.7 RXQ Yes No * I agree to the above terms and conditions
	Questions marked with * are required