CLAIM FORM FOR $25 Gift Card Confirmed Gift Delivery Address

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Acknowledgement of Terms I, ______________________________________ (Print Full Name), certify that I am over eighteen (18) years of age. My date of birth is ____________________. I am submitting this Claim form with the understanding that it will be relied upon to verify and confirm my entitlement to receive the sponsored by OnDemand Research: The next Level of Market Research. (______) (Print Initials)

In consideration of the receipt of the Gift, I hereby release and forever discharge the Sponsor and its officers, directors, employees, subsidiaries, affiliates, agents, assigns, etc. or any entity or person connected with the Gift from and against any and all claims, demands, losses entitled to assert, including but not limited to any death, injury, loss or enjoyment or other harm or loss of any nature whatsoever caused by, contributed to, or arising out of any gift awarded to me in this promotion.

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As stated, I understand that the gift I qualified for consists of a general gift card valued at $25. OnDemand Research: Next Level of Market Research reserves the right to substitute my gift with equal or greater value depending on the availability of the original gift. I understand that I will be disqualified from receiving any gift which may be awarded to me if any statement made by me in this Claim form is false and/or incorrect.

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Mail this completed Claim form to:
OnDemand research: The Next Level of Market Research MFL Rewards th 105 E. 34 St #144 New York, NY 10016

Instructions • IMPORTANT: Please be sure that all required fields are completed with accurate information. Inaccurate or incorrect information can, and will be reason for rejection. Read the Acknowledgement of Terms section carefully and print your initials as indicated. Once you have read and agreed on the terms, please sign your name confirming your acknowledgement. Please mail the original signed copy of the Claim form to: MFL Rewards. th 105 E. 34 St #144 New York, NY 10016 (Please keep a copy of the Claim form for your own record.) Questions? Email Customer Service at customer.service@ondemandresearch.com

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