NORITZ AMERICA CORPORATION’S RETROFIT REWARDS PROMOTIONInstructions to Contractor: Please complete either A or B (but not both), as applicable, and, if entering by purchasing a Qualifying Product, upload a photo of the installed Qualifying Product. Please complete below and upload a photo of the Entry Card bearing the numbers. NO PURCHASE NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE A PARTICIPANT’S CHANCES OF WINNING A PRIZE. CONTRACTORS MAY ENTER BY AMOE PURSUANT TO THE OFFICIAL RULES [LINK] PLEASE REFER TO SPONSOR’S PRIVACY POLICY AT [LINK].What type of plumbing entity are you?*Sole Proprietor/Individual located in United States or District of ColumbiaCorporation, LLC, etc. located in United States or the District of Columbia:A. If Contractor is a sole proprietor/individual located in one of the United States or the District of ColumbiaA. Contractor's Full Name (including DBA if applicable)* First Last DBA (if applicable) A. Contractor's Primary Business Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (or residential address if Contractor has no separate business address)A. Mailing Address (if different from Primary Business/residential address as listed above* Same as previous Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address will be used for Payment as wellA. Contractor’s age at time of entry in Promotion:*A. Contractor’s Date of Birth at time of entry in Promotion:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920A. Contractor's Contact InformationA. Email* A. Phone*B. If Contractor is an entity such as corporation, LLC, etc. organized and existing in one of the United States or the District of Columbia:B. Contractor’s Legal Name (including DBA if applicable) and Place of Organization (e.g., ABC Corp, a California corporation):* Contractor Legal Name Entity Type (Corp, LLC, etc) State of Organization B. Contractor’s Primary Business Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code B. Contractor’s Primary Mailing Address (if different from Primary Business Address above)* Same as previous Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code B. Contractor's Contact InformationName* First Last Suffix Email* Phone*Contractor Certification.By submitting the above information, Contractor certifies to NORITZ AMERICA CORPORATION (“Sponsor”) that as of the date Contractor entered this Promotion, through and including the date of this Affidavit, the undersigned represents that the above information is true and correct, that I have complied with the Official Rules, and that Contractor was not and is not: (A) an employee, officer, director, or a member, of the immediate family of an employee, of (i) NORITZ AMERICA CORPORATION (“Sponsor”), Q GROUP, INC. (“Fulfillment Company”), or their respective parent companies, affiliates, subsidiaries, advertising, contest, fulfillment and marketing agencies (collectively with Sponsor and Fulfillment Company, the “Promotion Parties”), or (ii) wholesalers of Sponsor’s products, or their respective parent companies, affiliates, subsidiaries; (B) living in the same household as such individuals (whether legally related or not); or (C) a homeowner or other consumer (except that a Contractor who is an individual sole proprietor may be a homeowner as long as Contractor’s entry into the Promotion is on the basis of being a Contractor as defined in the Official Rules and not as a homeowner or other consumer). (Immediate family members are defined as spouse, partner, parents, legal guardians, in-laws, grandparents, siblings, children and grandchildren and those living in the same household shall mean people who share the same residence at least three (3) months a year, whether legally related or not.)Noritz Retrofit Rewards Promotion Entry Card Scratch Off Numbers:Winning Serial Number*Heater Model Number*Heater Serial Number*Upload Photo of Installed Qualifying ProductIf entering by purchase of a Noritz Pre-Mix Models (EZ98, EZ111, NRCR92, NRCR111) (“Qualifying Products”) purchased by Contractors between June 1, 2023 and August 31, 2023, or while supplies last (the “Entry Period”), please click [HERE] to upload a photo of your installed Qualifying Product. NOTE: NO PURCHASE IS NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE A PARTICIPANT’S CHANCES OF WINNING A PRIZE. CONTRACTORS MAY ENTER BY AMOE PURSUANT TO THE OFFICIAL RULES [LINK]Image File of Installed Heater and Serial* Drop files here or