Get Your $50 Visa® Gift Card!

To qualify for this promotion, please complete this form. Provide your contact details, let us know if you're a new or current Vericom customer, and share when you plan to place your first $100+ website order. If you already have a Vericom website account but haven’t placed an online order yet, you’re still eligible!

Important: This form must be completed before placing your website order to ensure eligibility. Offer valid for U.S. customers only (no P.O. boxes).

First Name: Ex. John

Last Name: Ex. Doe

Company Name: Ex. Fictional Corp

Job Title: Ex. Purchasing Manager

Company Email Address: Ex. john.doe@fictionalcorp.com

Phone Number: Ex. (123) 456-7890

Recipient Name & Mailing Address for Gift Card (U.S. only, no P.O. boxes): Enter the name to be printed on the gift card and the mailing address where it will be sent. Ex. John Doe, 1234 Elm Street, Springfield, IL 62701.

Are you a current Vericom customer and purchased from Vericom before? Select 'Yes' if you've purchased from Vericom before, whether via the website or not. This helps us get you set up to place a qualifying web order for the gift card.

When do you plan to place your qualifying order? Ex. 2025-03-01 (Planning to purchase $100+ via the Vericom website on March 1st, 2025). The date you select is just an estimate to help us prepare; you are not obligated to order on that exact date.

Any additional comments or questions? Ex. I need help placing a qualifying order. Can someone contact and assist me? Thank you!

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