Customer ID	Always begins with the letter "C"
First Name
Last Name
Street Address 1
Street Address 2
City
State	Select Alabama Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Birthday	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Gender	Select Male Female
Email
Please let us know if.... -You have lost or damaged your tag and are requesting a new tag. -You are updating your existing FastBack Rewards Account. -You need to merge a new tag with your old account. This process will join your old tag with the new one you are currently using. -You have any other questions or concerns about your FastBack Rewards account.

PROTECTING YOUR PRIVACY
In order for you to get the most out of your membership, we need your cell number, email address and other contact information. But you have our promise never to sell any personal information you provided about to you to any third part under any circumstance – EVER. It will only be used to keep you eligible for drawings, platinum membership and rewards valued at $10 or more. And if you ever receive special offers from manufacturers, they'll come directly from us via text message.

Copyright GPM Investments, LLC. 2009. GPM Investments, LLC Fas Mart/Shore Stop Corporate Office 8565 Magellan Pky, Ste 400 Richmond, VA 23227 (804) 730-1568