Please ONLY put in ONE TEAM at a time.

Your name:
Your mailing address:
Mailing address/Addition space:
City:
State:
Zip Code:
Provide your E-Mail Address:
What League are you in:
What is your Teams Name:
Social Security #
(Must provide to collect winnings):
   
Please send Payment for Winnings?
Past Winnings
2004 Winnings
   
If you have any comments please let use know.
Any past due payments due you will be paid with
an additional 2.5% interest per month.


By sending this form you acknowledge that you have read and agreed 
to the official terms of US Fantasy Sports.  You also understand
that your Electronic IP Address serves as your Signiture.