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Prefix * First Name * Last Name *
Street Address * Apt / Suite / etc
City * State * Zip Code *
Email Address *
Phone Number or Numbers *
Can be used in place of a physical card
at the time of purchase.
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(only month and day are required)
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Do you purchase Dog and/or Cat food? If so, what Brand?
Do you purchase Horse or/and Livestock Feed? What Brand?
Do you purchase food for Wildlife & Caged Birds from River City Farm?
Referral Code (Office Use Only)
Clerk Number (Office Use Only)

Once submitted, your Phone Number will serve as your card number.
***No card necessary***