MyCouportiera Cupid Event  Gift Fulfillment Form
MyCouportiera Thanks you for being such a wonderful Fan.  We appreciate the time you spend each day with us reading, sharing and liking our post.

Please Complete the form below.

Best regards,
MyCouportiera Team
(Please Note we will not share your information. This form is necessary for us to process and track your gift or prize.)
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Please enter your name? *
What did you participate in to receive a link to this form? Please select one of the items below. This will help us process your reward in a timely manner. *
What did you participate in to receive a link to this form?
Required
What was the gift or prize you received? *
Please list gift or prize item i.e Target card,  Coupon envelope, Amazon Code etc
 Which MyCouportiera Team member issued the Prize or Fan Alert? (CHOOSE) *
Please read the post to determine team member.
Required
Phone number:
We will not give your phone number out to any third party companies, we ask for your number in case we have any issue with mailing address etc.
What is the best email to reach you? *
Please include the email that you use for paypal etc.
Shipping Address: *
City: *
State: *
Zip Code *
I've read and understand MyCouportiera Prize and Giveaway Policy?  (please copy and paste this link into a new browser http://bit.ly/wF43iy) *
Required
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