Abstract: A single sheet paper form contains upon a first side the complete face of a negotiable instrument, nominally a check. Upon the opposite second side are printed one or more coupons in an image area which is partially overlapping of the oppositely juxtaposed image area of the check upon the first side. Severence of the check from the entire form is required in order to negotiate it, simultaneously dividing the coupon(s) and rendering it (them) unredeemable. Alternatively, severance of the one or more coupons from the entire form is required in order to redeem such coupon(s), simultaneously dividing the check and rendering it non-negotiable. The benefits promised, amounts, conditions, exercise dates, and other parameters of the check and the coupon(s) are completely independent. Further elements including a contest entry blank may be incorporated upon either side of the form, and either in alternative or non-alternative relationship to existing form elements of check and coupon(s).