Request a Partnership Perks Card
Please use this form to request your Partnership Perks discount card.
Enter your full shipping address as this is the address the cards will be mailed to. Please allow 5-7 days to receive your requested card(s).
First and Last Name *
E-mail address *
Phone number *
Street Address *
City, State, and Zip Code *
Number of Cards Requested *
How did you hear about the Partnership Perks program? *
LIC Affiliation *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.