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Bloom Rewards Application
 
Viviano Bloom Rewards Application
Complete this form and click on "Send" to for your Bloom Rewards Number.
*All fields are required.
Have you applied before?No Yes - I need a replacement card
   
Name:
Spouse's Full Name (If Spouse will use account)
Address:
City:
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Zip:
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Home Phone:
   
I have read and agree to the Official Rules.
Yes - sign me up for Viviano’s Bloom Rewards!
By checking this box, you confirm that you are at least 16 years of age.

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Three Metro Detroit Michigan Area Locations: Chesterfield Township, Shelby Township, Saint Clair Shores  
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