Submit a Reward - Drug Free Clubs of America

Merchant-Reward Sign Up

Merchant Information:

Company Name *

Company Phone Number Format: 10 digits {Not Required: +1, (), -}

Contact Title *

Contact First Name *

Contact Last Name *

Contact Email *

Contact Phone Number * Format: 10 digits {Not Required: +1, (), -}

Address of Participating Location:

Address Line 1 *

Address Line 2

City *

State *

Zip Code * Format: 12345 or 12345-1234

Reward Information:

Reward Name *

Additional Participating Locations

Reward Limitations
(Will Appear on Reward)

Administrative Notes