Please, enter the information requested in the form below. Please, provide the name, email address, and phone number for the intended registered cardholder. This helps us reference the account information. You may enter as few as 1 and as many as 5 Lorts issued Acknowledgement # / Invoice # numbers on this form. Rewards are processed and conveyed to the card company when an order has been both invoiced and shipped to the Lorts customer.
* Reward claim submissions will not be processed until after the order has been shipped and invoiced.
Also, reward submissions must be made within 90 days of the invoice date to qualify.
Please fill out this form completely. If you move or your name changes, update your account information by email. email@example.com
The Visa® Reward Card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. and can be used wherever Visa debit cards are accepted. The Bancorp Bank; Member FDIC. Lorts reserves the right to modify, append, or end the program at any time.
All information submitted is confidential and will not be sold or shared outside of Lorts Manufacturing.