Clarko Bingo Company

Perk Point Redemption Form

TO BE USED FROM 12-3-2012 TO YEAR END

*** After hitting Submit, you may print a copy of the details for your records ***

*** Points must be redeemed the year they were earned and do not carry over ***

Customer Name:
Address:
City:
State:	(Enter 2 letter code. Example: KY)
Zip:	(Enter 5 digit zip code. Example: 43130)
Contact Number:
Contact Email:
License Number:

Item Name:		Points Needed:
Item Name:		Points Needed:
Item Name:		Points Needed:
Item Name:		Points Needed:
Item Name:		Points Needed:

All points will be verified (i.e. voided purchases, unpaid invoices) before orders are placed.
THANK YOU FOR PARTICIPATING!