KickBack Blitz KickBack Blitz Winner Submission Store Number:*SELECT STORE01020304050607080910111213141516171819202122242526272829303132333435363738394041424344454647485051525354Select Prize Amount:* 200 400 600 800 1000 1500 Customer Name:* First Last Phone Number:*Enter customers phone number. KickBack Card Number:* You must enter a valid Kickback card number. Please double check the number so there are no issues in rewarding the customers winnings. Δ REGISTER CARD