Gas Card Giveaway Registration

Do you research cars online before you purchase?

Never Occassionally Usually Always

What type of vehicle do you plan on buying in the next six months?

Car Truck SUV None

Approximately what price range are you looking at?

Under $20,000
$20,001 — $25,000
$25,001 — $30,000
$30,001 — $35,000
$35,001 — $40,000
Over $40,000

Do you have a target monthly payment for your new vehicle?

None — Paying outright / Not financing
$300 or less
$400 or less
$500 or less
$600 or less

first and last name

address

city, state, zip

email address
phone number (with area code) () —
Are you currently a Westmark member? Yes No	Age (must be 18 or older to qualify)

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We respect your privacy. Information gathered for this giveaway will NOT be shared, sold or leased. Entrants must be 18 years of age or older. Only one entry per person. See Official Rules.