Award Headquarters, P.O.
Box 31504, Tampa, FL 33631-3504 • 1 (800) 8540790
ScoreCard® Award Order Form PLEASE PRINT CLEARLY
Card Account Number Item # Award Description Color/ Qty Pts Required
Size
Last Name First Name M.I.
Business Name (Required only if merchandise is being shipped to business address / include suite no
.)
Street Address (DO NOT USE P.O. BOX GIVE STREET NAME AND APARTMENT NUMBER)
City State Zip
Daytime Phone Home Phone
Social Security No:
(last four digits only)
Card Sponsoring Institution
Date
Signature (Required)
Email Address Total Points
Required
Your order cannot be processed if this order form is not signed and/or if you have not provided complete information including your card number, last four d
igits of your Social
Security number and street address (No P.O. or A.P.O. Boxes). Submission of your order signifies that you have read and agree to abide by the ScoreCard Bo
nus Point Program Rules. E-mail addresses will be used to send award certificates and/or award confirmations as well as program marketing information.