For every 50 feedback forms submitted, Gingera will be awarding one lucky winner a $100.00 American Express Gift Card. *

Please complete the form below for your chance to win!

Please note: Fields marked with * are required

Your Full Name*
Complete Street Address*
City, State & Zip*
Email*
Prior to trying Gingera, which antacid were you using?*
After trying Gingera, how likely are you to switch to Gingera?*	Very Likely Not Likely
Which supermarket do you most frequently shop at?*
Please arrange the following attributes in order of importance to you: * FDA Recognized Made from all-natural ingredients Contains real Ginger Instant heartburn relief
We would love your feedback! Please share your comments with us.*

By submitting this feedback form, you hereby grant consent to utilize the information contained therein for the purposes of, but not limited to, product testimonial, promotion and advertising by or on behalf of Gingera, and/or any of it's affiliates.

* Limited to one entry per household. Gingera reserves the right to discontinue this promotional opportunity at any time.