Claim Submission Form

For use with any of our family of survey sites. Only one submission is permitted per household. All submissions are manually reviewed.
    

You must fill out a claim to receive the cash payout for our promotional offer. Check our website for rules.
Tips to a successful claim: Fill out ALL relevant fields. Make sure the surveys you submit are on the approved list. Make sure you do the
correct number of surveys for your country of residence. This number changes daily, so be sure you know what it is today.
We pay via PayPal only.

First Name  
Last Name  
E-mail  
PayPal E-mail.  

Select your country of residence from the drop down menu:

 

Survey 1 Name (Must match our list)

 

Confirmation Proof

 

Survey 2 Name (Must match our list)

Confirmation Proof

Survey 3 Name (Must match our list)

Confirmation Proof

Survey 4 Name (Must match our list)

Confirmation Proof

Survey 5 Name (Must match our list)

Confirmation Proof

Survey 6 Name (Must match our list)

Confirmation Proof

Survey 7 Name (Must match our list)

Confirmation Proof

Survey 8 Name (Must match our list)

Confirmation Proof

Survey 9 Name (Must match our list)

Confirmation Proof

Survey 10 Name (Must match our list)

Confirmation Proof

Survey 11 Name (Must match our list)

Confirmation Proof

Survey 12 Name (Must match our list)

Confirmation Proof

Survey 13 Name (Must match our list)

Confirmation Proof

Survey 14 Name (Must match our list)

Confirmation Proof

Survey 15 Name (Must match our list)

Confirmation Proof

Survey 16 Name (Must match our list)

Confirmation Proof

Survey 17 Name (Must match our list)

Confirmation Proof

Survey 18 Name (Must match our list)

Confirmation Proof

Survey 19 Name (Must match our list)

Confirmation Proof

Survey 20 Name (Must match our list)

Confirmation Proof


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