Lottery Entry Form

Mall-One.com

Thank you for shopping at Mall-One.com. Please enter the required information below. You will be entered into the next 2 Lotto drawings. If you are one of our winners, you will be contacted at the email address you provide below. You may also provide additional contact information in the space provided. Remember, you may enter every time you make a Mall-One.com purchase.

Please note that the information you provide below is kept confidential and will not be shared with anyone. It shall solely be used for the purpose of this Lottery entry.

Customer Name   
E-mail Address             
Purchase Date  
Amount of Purchase  

Name of Store  

                                         CLOSE

Additional Information