Daly Diner Application

Now is the time to make your move! By becoming a Daly Diner you will begin receiving a 5% credit on each and every purchase that you make at Daly. This includes carry-outs, Daly Specials and even when you use one of the many coupons found on this website. You can use your credits either a little at a time or save them up for free meals. You will also receive special discounts throughout the year. So don't delay. Register online right now to receive you shiny blue Daly Diner Card!

Name *

Birthdate *

Address *

City *

State

Zip Code *

Phone *

Email *

Family Members / Birthdays

Family Member 1 Name

Family Member 1 Birthdate

Family Member 2 Name

Family Member 2 Birthdate

Family Member 3 Name

Family Member 3 Birthdate

Any information provided will remain strictly confidential. We do not sell, distribute or in any way make available any of the above information to any third party. We reserve the right to alter or cancel this program and any associated offers at any time without reimbursement for unused credits without notice. Only the person paying the bill may be credited with points. Taxes and gratuities are not eligible for points. *

I agree to the above terms and conditions.