Loft Benefits Enrollment

Please fill out the form below to enroll in the 2025 Loft Benefits program. Only one submission per household is needed. If you have a joint account, please fill in both account owners names and emails.

Full Benefit List and Instructions

Loft Benefits 2025 Enrollment Form

Name(s)

Last Name

Primary Email

Secondary Email

Benefit Choice

Select one benefit from the options below.

Client Code

Please enter your unique client code

I agree to Loft Benefits terms & conditions (see below)

Click for Terms and Conditions

Loft Benefits Enrollment

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