GATEWAY REWARDS PROGRAM REGISTRATION

To register for the Gateway Rewards Program, it is necessary to fill in the following information below. Once your account has been created, you will receive an email confirming your application and a Gateway Rewards Card will be mailed to you within 2 - 3 weeks. Once you receive your card, you must activate your account with the unique 7 digit PIN number on the back of your card. Please go to the "my account/login" tab to complete your account setup and registration of your card.
Personal Information:
* required field
	*First Name:
	*Last Name:
	Company:
	*Address 1:
	Address 2:
	*City:
	*Province/State:
	*Postal/Zip Code: (A2A2A2) or (22222 or 22222-2222)
	*Country:
	*Phone: (888-555-5555)
Email Address:
We need an accurate email address so we may notify you of account activity and provide your username and a temporary password if you forget it.
	*Email Address:
	*Retype Email: