FRESH Rewards - Customer Sign-Up
1. Name
*
First Name
Last Name
2. Email
*
example@example.com
3. Phone Number (optional)
Please enter a valid phone number.
4. Did you pick up a Loyalty Card from our store?
*
Yes
No
5. If you answer 'Yes' to the above question (4), please provide the number on the back of the card.
If you answered 'No' to question 4, how would get like to get your card?
Please post to my address below
I will pick up in-store
Address (optional)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select how much you would like to hear from us.
Please send Weekly Specials to my Email
I'm happy to receive personalized offers to my Email
I would like to receive an occasional text message offer
Any comments that you would like to add?
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm