WBAT

Lotto Tickets

 

 

GIFT CARD REDEMPTION

 

Use this form to redeem your gift card to purchase one lottery ticket! Please print legibly and fax completed form to (562) 425-5141 . Thank you for your participation.

 

Name:

Employee Number:

 

Employer:

 

Phone________________ Fax_______________ E-mail_________________

 

Department________________Address________________City____________________

 

 

 

Who should we contact in your work area to arrange a benefit review?

 

 

_______________________ ____________________ ___________________

N ame Title Telephone