Competition Entry Form
First Name
Last Name
Date Of Birth
Address
State
Postcode
Phone
Email Address
Receipt Number
OR Order Number
Receipt Number example
×
Store of Purchase
Where did you hear
about this promotion*
Please select options below
Radio
TV
Website
Receipt
In-Store
Email
Others
Which Store:
Please specify:
I confirm that I am 18+ years old and I have retained my receipt and have read and agree to the
Terms and Conditions
and
Privacy Policy
.
I would like to receive further marketing, promotional information, and email newsletters from Chemist Warehouse.
Terms and Conditions
and
Privacy Policy
ENTER NOW