Rockford Rewards™
Cardholder Inquiry Form

• Contact Name:

• Home Address (Street and number):


• City:
• Province:
• Postal:


• * Email: My birthday is: (mm/dd/yyyy)



• * Rockford Rewards™ Card Number:

Please check all that apply

• My name is spelled incorrectly. Please update as printed above. 


• I need to change or confirm my address. Please update as printed above. 


• I did not receive my Postcard for my FREE Appetizer Or Dessert Valued To $8.00.

• I did not receive Bonus Points for giving my valid email address.


• I did not receive Bonus Points for Referring My Friends. I submitted a completed Refer-A-Friend form for the following people:



• Friend's Name:


• Friend's Name:


• Friend's Name:



• Other Inquiry:
  

* indicates a required field

Providing this information constitutes my permission for the exclusive use of the Royalty RewardsTM Program to

Rockford Rewards™ will do everything possible to investigate your inquiry. A valid email must be provided in the area above to receive a response. Thank you for your participation in the Rockford Rewards™ Program!