Simon Malls | More Choices®

Account Information *Indicates Required

• *Email address:
  
• *Create your Password:
  
• *Confirm Password:
  

• *First Name:
  
• MI:
  
• *Last Name:
  
• Suffix:
  - - Esq. Jr. MD. Sr.

• *Company Name:
  

• *Street Address Line 1:
  

• Street Address Line 2:
  

• *City:
  
• *State:
  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
• *ZIP:
   

• *Job Title:
  

• *Contact Number:
   -  
• Fax Number:
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• Type of Business:
  
• Department Function:
  

• *Intended Use Of Cards?
  
• Estimate Order Frequency
  Please Choose Weekly Monthly Quarterly Yearly
• What Quantity?
  Please Choose 5-24 Cards 25-99 Cards 100-249 Cards 250-499 Cards 500+ Cards

• Company size: (employees)
  Select One Less Than 50 50 to 100 100 to 500 More than 500
• Company Website:
  

• How did you hear about us?
  

Activation Option

• Automatic Activation
• Self Order Activation

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The Visa Rewardcard is issued by MetaBank or U.S. Bank National Association
pursuant to a license from Visa U.S.A. Inc.

Use only at US merchants that accept American Express Cards except cruise lines and casinos. Not for use at ATMs or for recurring payments. Except where required by law, this Card is not redeemable for cash. No fees after purchase. For more information, customer service, or Cardholder Agreement visit simongiftcard.com or call 1-800-331-5479. Issued by American Express Prepaid Card Management Corporation.