Centricity Rewards

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Participant Registration

Please complete this form to register.

Dealer Number
First Name
Last Name

BUSINESS ADDRESS

Address
City
State/Province
Zip/Postal Code
Country
Business Phone

MAILING ADDRESS

Address
City
State/Province
Zip/Postal Code
Country

Please use your work email address. This will allow us to accurately credit your rewards.

Email Address

We require your SSN to issue a 1099, as mandated by the IRS for accurate income reporting. Your information is secure and used only for tax purposes.

SSN#

Digits only please, no spaces or dashes.

Create a username and password for this account. Your password must be at least 6 characters long, 1 capital letter and 1 special character.

User Name
Password
Re-enter Password
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