FIRST
NAME: ______________________ LAST NAME: ______________________
PHONE
#: (_____)______ - ___________ DATE OF PURCHASE: ____/____/______
DIRECTV
ACCOUNT #: ________________ CONFIRMATION # _______________
STREET:
__________________________________________
CITY:
_____________________________ STATE: __________ ZIP: _____________
DIGIWORLD
9925 CANOGA AVENUE UNIT A
CHATSWORTH, CA 91311
REQUIREMENTS:
● Complete Fill-Out Form
● Credit Card To Cover The Shipping And
Handling Fee For $29.99 (Any other form of payment will not be
accepted, no checks or money orders).
CREDIT
CARD INFORMATION: ○ VISA ○ MASTERCARD ○ AMERICAN EXPRESS
CREDIT CARD NUMBER:
EXPIRATION
DATE:
_____/_________ CCV
3 DIGITS: ____________
ELIGIBILITY
DETAILS: HOME THEATRE SYSTEM VOUCHER
IS A LIMITED TIME OFFER FOR NEW RESIDENTIAL DIRECTV® CUSTOMER WHO PURCHASED A
DIRECTV® SYSTEM FROM DIGIWORLD BETWEEN MAY 1st TO DECEMBER 31st 2005.
REDEMPTION FORM MUST BE SUBMITTED WITHIN 120 DAYS OF ACTIVATION.
PLEASE ALLOW 6 – 8 WEEKS AFTER RECEIPT FOR DELIVERY.
TERMS
AND CONDITIONS: A
CORRECT MAILING ADDRESS IS REQUIRED. OFFER LIMITED TO US RESIDENTS. MECHANICAL
REPRODUCTION OF THIS FORM STRICTLY PROHIBITED. VOID WHERE RESTRICTED OR
PROHIBITED BY LAW. NOT VALID WITH ANY OTHER OFFER. LIMIT 1 OFFER PER HOUSEHOLD.
DIGIWORLD INC. IS NOT RESPONSIBLE FOR LOST, LATE, ILLEGIBLE, MUTILATED,
INVALID, INCOMPLETE, STOLEN, MISDIRECTED OR POSTAGE-DUE SUBMISSIONS. THIS FORM
ENTITLES YOU TO A GIFT ONCE ALL OF THE ABOVE OBLIGATIONS ARE MET. RECIPIENT
ACCEPTS ALL LIABILITY FOR ANY AND ALL DAMAGES CAUSED OR CLAIMED TO BE CAUSED
ARISING OUT OF USE OR REDEMPTION OF THIS OFFER.
IN
THE EVENT THAT A RECIPIENT DOES NOT FULFILL THEIR ANNUAL CONTRACT WITH
DIRECTV®, DIGIWORLD HAS THE AUTHORITY TO CHARGE THE RECIPIENT THE TOTAL AMOUNT
OF THE HOME THEATRE SYSTEM (UP
TO $100) WITH THE CREDIT CARD INFORMATION PROVIDED ABOVE. IF YOU HAVE ANY
QUESTIONS REGARDING THIS OFFER PLEASE CALL 1-800-814-4707.
APPLICANT
SIGNATURE________________________________________ DATE:____________________________________________