Kick Back Rewards Sign Up Do you have a new points card you need to register?Please fill out the form below to complete your registration.If you don’t have a card yet, stop by any of our locations to pick one up! Card Registration Card Number* Activation Code* 6 digit code on the back of your loyalty card Name First Name* Last Name* Address Street Address* Apt, Suite, etc. City* State* OK AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY AB BC MB NB NL NT NS NU ON PE QC SK YT Zip* Mobile Phone & Email Mobile Phone Please do not include dashes, spaces, or parentheses. Email I want receive messages and offers. I agree Card Pin Please choose your 4-digit PIN * By submitting this form you agree to the term and conditions at Kickback Systems SUBMIT