Kroger Rewards Sign Up Sheet
First Name *
Your answer
Last Name *
Your answer
Do you have a current email address
Address *
Street address
Your answer
City, State, Zip code *
Your answer
Kroger Rewards Card Number *
This number is on the back of the card
Your answer
Kroger Store location
What is the location of the closest Kroger store where you do your shopping
Your answer
Permission to create an email address *
Yes or No
User name
This is for a User name for the Kroger Website, when you sign-in
Your answer
Permission to create Kroger Reward Account *
Required
Phone Number where you can be contacted
Your answer
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