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 Rater Rewards Form

Please complete and submit the form below. Remember to submit your proof of purchase to service at consumerraters.com or 1121 S. Military Trail, 314 Deerfield Beach, FL 33442. If sending by mail, please include the required fields below. Once we have received this form and your proof of purchase, you will receive your cash incentive within 30 days.

* Fields Required

First Name *
Last Name *
Mailing Address *
City *
State *
Zip *
User Name *
Email *
Business Shopped/Rated *
Business Shopped/Rated
Business Shopped/Rated
Security Code:
Please enter the 5 character code you see in the image to the left.
Code:
 
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