GREEN CHOICE REWARDS MembershIp

Name *

First Name

Last Name

Registered Address *

This will be the address that the Green Choice Rewards program will be registered to.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How did you hear about the program? *

While Shopping at the Garden Center

Letter in the Mail

Email

Search Engine

Social Media Post (Facebook, Instagram)

Ads (Google, Facebook, or Youtube)

TV

Word of Mouth

Other

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Auto Pay Terms and Conditions *

Auto Pay Opt-In Information Via Credit Card: I (we) hereby authorize Landscape Garden Centers to electronically debit my (our) credit card account detailed above in the amount of $100.00 + tax, annually. This authorization is to remain in full force and effect until I (we) notify Landscape Garden Centers [in writing with the appropriate address] of its termination. I (we) understand that Landscape Garden Centers requires at least 30 days' prior notice in order to cancel this authorization. Auto Pay Opt-In Information Via ACH: I (we) hereby authorize Landscape Garden Centers to electronically debit my (our) account at the depository financial institution detailed above in the amount of $100.00 + tax, annually. If necessary, Landscape Garden Centers may electronically credit the account to correct erroneous debits. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with all applicable laws. This authorization is to remain in full force and effect until I (we) notify Landscape Garden Centers [in writing with the appropriate address] of its termination. I (we) understand that Landscape Garden Centers requires at least 30 days' prior notice in order to cancel this authorization.

Agree

Decline (registration will not be completed)