Shield Card America -- Registration

By registering with us, you'll be eligible to receive special offers and discounts from Shield Card America. By registering today, you'll also be entered into the Bi-Monthly Drawing.

Notice: If you are registering because you or your department received a faxed offer/solicitation then your registration is for the daily, weekly, or monthly drawing described in the faxed document

Please complete the form below. All information submitted must be complete and accurate to qualify for the winning registration or the FREE gift.

FREE Gift Limited to one official email address registered per month or one per purchase.

Name:

Agency:

Title:

City:

State:

Official Agency:

Email Address:

Confirm Email Address:

Personal:

Email Address:

Confirm Email Address:

Which email address would you prefer correspondence with?

Agency Email Personal Email

Business Phone:

Cell Phone:

Business Fax:

The security code and SSL (Encryption) mode has been enabled to protect your information.

Security Code:

Confirm Security Code:

^{I specifically authorize Shield Card America (SCA) to communicate with me using this Email address and Business Fax No. for any legitimate purpose, including notification of this drawing. Additionally, I permit SCA to send
Email notices to me that will keep me informed of new products, special offers and promotions offered by SCA exclusively.
All Email from SCA is certified Virus-Free SCA further certifies that your information is confidential, secure and will NOT be given to ANY third party.}