Weekly Circular Signature Items Rewards on the House

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Rewards Card Request Form


To register for a Rewards Card or update your current one please fill out the form below, or click here for a PDF version that you can fill out and bring to the Customer Service counter of your local Hen House Market.

* =Required Field
Please select a request type (Select all that apply)*:
New Customer Name Change Address / Phone Change Replacement Card

First Name*:
Middle Initial:
Last Name*:
Address 1*:
Address 2:
City*:
State*:
Zip*:
Primary Phone*:
Secondary Phone:
E-mail Address*:
New/Current Account #:
(Leave blank on new applications)
Previous Account #:
(Leave blank on new applications)