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REGIONAL OFFICE

222 Purchase Street


Tel: (203) 831-0600
# 291
Tel: (203) 831-0642
Rye, NY 10580-2101
Fax: (203) 838-0352
Web Site: http://www.hole-in-WON.com
vp@hole-in-WON.com
1-203-219-3090 URGENT CELL ASSISTANCE!!
HIW Rep:
Contract Date :

HOLE-IN-WON.COM HOLE IN ONE CONTRACT

Amanda Penrose
Email :
vp@hole-in-WON.com
Contract Number:
3/3/15
Contract Fee: $
======================= Client Information =======================
Company Name :
Contact Name 2:
Client Code:
Telephone 2 :
Tournament:
Cell Phone:
Contact Name:
Email:
Telephone :
Ext:
Fax :
Address :
City:
State:
Zip:
======================= Course Information =======================
Golf Course:
Pro/Tourn Mgr:
Email:
Telephone :
Fax :
Address :
City:
State:
Zip:
====================== Tournament Information =====================
Date:
Shots Day 1
Shots Day 2
Shots Day 3
Total Players: Men:
Amateur:
Pro:
Women:
Amateur:
Pro:
Hole Number
Yardage
Prize
Sponsor Information
$
$
$
$
$
$
$
$
Ship Signs:
To Contact:
To Course:
To Other:
See Instructions:
Other Instructions:

Extra Gifts:

Descriptions &/or Special Arrangements or Situations


FIRST hole in one wins. Pros NOT eligible. See Terms, Conditions & Specific Rules for details.
Independent witness REQUIREMENTS on main prize hole(s).
Supplementary HIO awards maximum value $500.00.
Value and trip packages vary based on hole yardages.
4 Custom tee signs to be supplied by HIW. FREE Ground Shipping
MINIMUM yardage on main prize hole(s), 110 all others, unless stated. NO Exceptions.
Any claimant must use Liberty Travel agency for any prize awarded by Hole-In-Won.com that includes travel.
Air fare is NOT included in any prize.

ANY CONTRACT ISSUED WILL BE BASED UPON TERMS AND CONDITIONS FOUND ON THE REVERSE SIDE OF THIS APPLICATION AND
SPECIFIC RULES ADDENDUM. THE SIGNEE AGREES WITH THE TERMS AND CONDITIONS AND AUTHORIZES HOLE-IN-WON.COM TO RUN
CREDIT CARD ____________________________________________ FOR THE CONTRACT FEE IN ORDER TO BIND THIS COVERAGE. USGA RULES
AND SUPPLEMENTARY PRIZE RESTRICTIONS ALSO APPLY IN ALL CASES.
Contract is NON BINDING UNTIL receipt and acceptance by a signature, stamp or seal from Hole-In-Won.coms office prior to event and
that this is NOT an Insurance Policy or Product. This is a Prize Providing Agreement between the two parties, Hole-In-Won.com & the
client.
Client agrees to indemnify, protect and save harmless Hole-In-Won.com from any cost or expense arising from ANY claims by any
contestant, director, sponsor, organization or otherwise, alleged to have been caused by any act, error, omission, or otherwise, negligent
or non-negligent by any party.
CLIENT SIGNATURE CONSTITUTES UNDERSTANDING AND EXECUTION OF ALL PROVISIONS, TERMS & CONDITIONS HEREIN.

Client Signature:

Date:

ACCEPTANCE

Hole-In-Won.com. acknowledges receipt of this completed application and fee and agrees to provide the Hole-In-One Contest with Prize
Awards as requested above.
________________________________________________________________
Hole-In-Won.com Representative

_____________________________
Date

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