Complete the form below to order your LocalBenefits Rewards Card(s)™. There will be a $5 processing fee per card charged. When you click on "Submit" at the bottom of this form, you will be taken to a secure order page where you can make your payment via major credit card, debit or PayPal.  You will receive as our Thank You, a LocalBenefits Reward Certificate™, valued at $5 or greater, which can be redeemed at any participating merchant.
 

 

 
   
How did you hear about us?  
First Name  
Last Name

 
Email  
Mailing Address  
City  
County/Parish  
State  
Zip  
   
How many cards do you want to order?  
   
Where do you intend to use your card?  
   

Would you recommend a business

that you would like to see accept

the  LocaBenefits Rewards Card?

  
   
Comments
   

When you click submit, you will be taken to a secure payment page where you can make your payment via credit/debit or PayPal.

 

By ordering your card, you agree to the Terms & Conditions associated with

this card as well as to receive special notices by email from time to time.

 

 

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