CLAIM FORM FOR GIFT

CONFIRMED GIFT DELIVERY ADDRESS

Name: _______________________________________________________
Address: _______________________________________________________
Email Address: _______________________________________________________
Phone Number: _______________________________________________________
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 Gift by OnDemand
Research: The Next Level of Market Research.

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 of 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.

As stated, I understand that the Gift I qualified for consists of a general gift valued at
up to $25. OnDemand Research: Next Level of Market Research reserves the right to
substitute my gift with a gift of 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 on 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
105 E 34th 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 to the Terms, please sign your name confirming your
acknowledgement.
Please mail the original signed copy of the Claim Form to:
MFL Rewards
105 E 34th St., #144
New York, NY 10016
(Please keep a copy of the Claim Form for your own records)
Questions? Email Customer Service at customer.service@ondemandresearch.com