DEALER PROMOTIONS FORM

Proof of performance required, all invoices must show only one type of transaction. Contact information and copies of qualifying invoices must be submitted no more than 15 days after promotion end date. Prizes are delivered 6-8 weeks after submission deadline. Offer not valid with other promotions.

CONTACT INFORMATION

* denotes required field.

Company Name * This field is required.

First Name * This field is required.

Last Name * This field is required.

Address * This field is required.

City * This field is required.

State * Please select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------Canada Provinces: Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory This field is required.

Zip * This field is required.

Phone Number * This field is required.

Email * 

Total Number of Prizes Earned * This field is required.

PROMOTIONAL ITEMS ENTRY

QUALIFYING INVOICES

File type must have a .pdf, .jpg, or .jpeg extension.

If you have more than one file to upload, combine into one pdf to submit online or send invoices and redemption form to autopromos@agricover.com.

Your information will not be given out to a third party. Please check our Privacy Policy for more information.