Dawg House Customer Loyalty                        Enrollment Form

Important Instructions:

For accurate program participation, please print neatly in capital letters.

Your Loyalty Card will be available for use approximately 1-2 weeks after your application is processed.

If you wish to share an account with your spouse, please fill out information for both people on one form.

First Name:

Nickname:

Spouse:

Nickname:

Last Name:

Spouse (if diff):

Address:

City:

State:

ZIP Code:

Home Phone:

-

-

Cell Phone:

-

-

Spouse Cell Phone:

-

-

Email Address:

Spouse Email Address:

Birthday:

(MM/DD/YY)

/

/

Spouse's Birthday:

/

/

Signature:

Date:

Internal Use Only

Data entered in POS?

Y or N

Tab: Y or N

Check: Y or N

Card #: