YOU’RE A WINNER!

Well done on your win, please fill in this form to claim your prize

Name(Required)

First Last

Name of competition you won(Required)

Email(Required)

Please add the email registered to your RaffledUp account

Order Number(Required)

You will find this on the order conformation email

Was your prize a main prize or instant win?

Which prize/s did you win? (If you would like some prizes & some cash, please fill in 2 forms)

Would you like the prize or cash alt? (Only fill in if you won a prize)

Postage Address (Only fill in if you won the prize & would like the prize)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

How would you like to be paid? (Only fill in if you won /would like cash)

Bank Account Details (This is the SLOWER route – fill in if you won/would like cash

Name On Card

Account Sort Code (6 Digits)

Bank Account Number (8 digits)

Paypal Email Address (This is the FASTEST route – fill in if you won/would like cash)

Notes