Section B: Claim Information
Note: You are a guaranteed winner of one of the prizes listed above. Fill out the form below to claim your prize.
Failure to complete this form in its entirety may result in forfeiture of your prize.
a First Name
b Last Name
c Address1
d Address2
e City
f Postal Code
g Region
h Country
Your prize notification and FreeLotto entry confirmations, daily results and sponsored advertising messages will be sent by e-mail only from FreeLotto:
i Email
j Confirm Email
This confirmation is contingent upon meeting the age and residency requirement. These prizes are being offered by FreeLotto.com as part of a worldwide publicity campaign. Offer is valid for a limited time.
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