Gift Card Acknowledgement ← BackThank you for submitting your gift card acknowledgement. CMIS # Name of Screener Date (YYYY-MM-DD)(required) Applicant Name (Last, First, Middle Initial)(required) Pre-disaster Address(required) City(required) State(required) Zip Code(required) County(required) Select Alexander Alleghany Ashe Avery Buncombe Burke Cabarrus Caldwell Catawba Cherokee Clay Cleveland Eastern Band of Cherokee Indians of North Carolina Forsyth Gaston Graham Haywood Henderson Iredell Jackson Lee Lincoln Macon Madison McDowell Mecklenburg Mitchell Nash Polk Rowan Rutherford Stanly Surry Swain Transylvania Union Watauga Wilkes Yadkin Yancey Mailing Address (If Different) City State Zip Code County I received a gift card in the amount of:(required) Number(required) SubmitSubmitting form Δ
