Congratulations on being a recipient of an egiftcard from our Walmart.com Mobile App Survey.  Your email was randomly drawn from a survey you recently completed with us.  Please fill out this form in its entirety or you may forfeit your prize.  

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Please enter the email where you originally received your survey invitation so we can match up your prize acceptance form with the correct survey you participated in.  Your egiftcard will be sent to the email address where you originally received your Walmart.com survey invitation.