Rewards Program Signup Form


NOTE: Fields in BOLD TEXT are required, omissions may result in delays and/or exclusion in the program.
We reserve the right to refuse program participation for any reason.

Person Completing this Form

First Name:
Middle Int:
Last Name:
Street Address:
Address 2:
City:
State:    Zip Code: 
Area Code
& Phone #:
Your email:

Organization Information

Organization
Name:
Contact Name:
Street
Address:
Address 2:
City:
State:    Zip Code: 
Area Code
& Phone #:
Contact email:
Chapter
or Dept ID#:
Department:
Other Specify:
501(c)(3) or
Non-Profit ID
A Legal Tax ID or 501(c)(3) ID number must be on file before donation checks can be released. If you have this information available now, please enter it in the field provided. Otherwise, we must obtain this information from you before releasing any donations. 

Complete this application for each department you would like to have a coupon code generated for. Multiple coupons may be issued to the same organization but each coupon must be assigned to a different department.

  Example: The first coupon may be for the 'General Fund', the second coupon may be for the 'Music Ministry', etc.
  Each department requesting a coupon code must have separate appllication forms to accompany them.

Please provide us with a direct email address of the "Contact Name" person, generic email addresses may delay our ability to contact you with important information. We will not use this address for SPAM, only for direct contact purposes.

If you have questions or comments concerning the Century Disc Rewards Program, please contact our program administrator at: rmgpro@rmgproducts.com 
  Please check your application information before clicking on the Submit button.