Loyalty Rewards Enrollment How Can We Help You?* New Rewards Account Replacement Card Lost/Stolen Name Change Membership NumberWould you like us to mail you a card?* Yes, please mail my Loyalty Rewards card. No, I don't need a physical card. I'll use my phone number at checkout. Email* Date of Birth* MM slash DD slash YYYY Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Phone*Home Store State* Texas Louisiana Which Store Do You Shop At?*Please make a selection929 3rd Ave., Lake Charles4431 Nelson Rd., Lake Charles2830 Ryan St.,Lake Charles362 Sam Houston Jones, Lake Charles4950 Lake St., Lake Charles1717 HWY90 W., Vinton518 Russell, WelshHWY 165, Kinder505 E 4th St., DeQuincy796 HWY 26 N, Lake Arthur112 N Thompson, Iowa2013 Sampson, Westlake9058 Shreveport HWY, Leesville2227 Maplewood Dr., Sulphur12054 Texas HWY Toledo Town, ManyWhich Store Do You Shop At?*Please make a selection6001 39th St., Groves212 27th St., Nederland2005 Texas Ave., Bridge City3709 N 16th St., Orange5960 HWY 105, Beaumont3955 Phelan BLVD, Beaumont2255 N 11th St., Beaumont8350 Phelan BLVD, Beaumont11916 HWY 62 N, Mauriceville800 N Main, Vidor1328 HWY 124, Winnie5897 W Port Arthur Rd., Port Arthur864 Magnolia, Port NechesCoupons and Special OffersBy submitting this form, you are agreeing to allow Market Basket to contact you via email. Please select the other ways you'd like to receive coupons and special offers. Please Send Me Offers By Text Message (SMS) Please Send Me Offers By Mail Please read and agree to the Privacy Statement and Terms and Conditions*Privacy Statement: Your Privacy is protected! All of your personal information is completely confidential and will not be shared or sold to anyone by Market Basket, Loyalty Lane Rewards, or any affiliates or employees of either company. Your information will only be used by Market Basket to contact you with communications and special offers. You always have the option to discontinue these communications. Terms and Conditions: 1. Market Basket reserves the right to change reward values or modify the terms and conditions of the Market Basket Rewards program at any time. 2. The Market Basket Rewards program is the property of Market Basket and we reserve the right to terminate the program at any time. A 30-day notice will be given to Market Basket Rewards cardholders prior to termination. 3. Market Basket will always endeavor to provide proper reward values for shopping, and will correct any reasonable errors, but can not be responsible for all alleged errors. 4. Phone number in lieu of card is designed as a backup only. Market Basket will endeavor to correct any reasonable errors, but cannot be responsible for phone number(s) errors or duplicate phone numbers on record. 5. Market Basket reserves the right to terminate rewards accounts if they have been inactive for a year. 6. Market Basket also reserves the right to terminate any balances over a year old. This is subject to change with a 30 day notice. 7. Market Basket cannot be responsible for the actions of employees or associates of businesses or organizations or their behavior as it relates to the Rewards Program. Qualifying purchases may not include some products such as alcohol, tobacco and services. Rewards to be determined by Market Basket and subject to change and availability. I understand that my purchases may be recorded and may be used for marketing purposes. I am aware that I may receive information and special offers from this store. We value your privacy. All customer information is strictly confidential and will not be sold or shared. I agree to the Privacy Statement and Terms and Conditions.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.