Business Registration Form .•.Required Fields
Type Of Membership .•.
Please Use Letters for your Usersname. ( 6 Letters or more.)
Username .•.
Please Use Letters and Numbers for your password. ( 6 Letters and Numbers combined)
Password .•.
Contact Information * This information will appear on your first online coupon.
Company Name .•.
Contact for Coupon .•.
Address .•.
City .•.
State .•.
Zip .•.
Phone .•.
Fax
Toll Free Phone
Email .•.
Web Site
.
If you were referred by one of our Sponsors or Sales Affiliates please indicate below.
Referring Sponsor:
Type of Payment
Name on Card
Card Number
Card Expiration Date
If you are paying by check, please make payable and mail to: My Lakewood Card • 10600 W. Alameda Ave., Suite L2- Lakewood, CO 80224. If you are using your credit card, you will see a charge on your statement from RKL Digital Services for your membership.
Thank you for joining My Lakewood Card. As soon as we process your application we will send you comformation and a internet link to start adding your discounts or coupons.

Please fill out the following form to register your business as a full member of MyLakewoodCard.com and post your first discount coupon.  The fee for a full membership is $350.00 a year.   Full membership on MyLakewoodCard.com includes full membership to two of our partner sites: MyLakewoodGateway.com and MyColoradoGateway.com.

IMPORTANT:  The contact information you provide in the form below will be the contact information that appears in your first online coupon.  After you register and receive your username and password you may log into the members area and add up to four additional coupons.  LAKEWOOD, COLORADO BUSINESSES ONLY