Loyalty card application form

Ex Shop named "loyaltycard" replace the "loyaltycard" and use your shop name

Getting a Smart Loyalty Card is easy and it is FREE!

Simply fill in the loyalty card application form below. You will receive your own loyalty card and become a member of our loyalty program and you will start to collect points, freebies, special offers and gifts each time you shop at our "loyaltycard" shops. Turn your everyday shopping into more points and more freebies you get.

Fields marked * are required.

Name Mr / Mrs / Miss  ____________________________________

Address                        ____________________________________

    ____________________________________

    ____________________________________

    ____________________________________

City                              ____________________________________  

Pin code                       ________________

Home Telephone Number   ________    _________________

Office Telephone Number  ________    _________________

Mobile Number                ___________________

Email Address              ____________________@________________

Date of Birth                 __ /__ /____

(dd/mm/yyyy)

Number of Family Members  _________

Monthly Shopping Budget for family   Rs. _________

Monthly Saving Budget   Rs. _________

From time to time "loyaltycard" Shop will use the information that you have provided in this form to direct special offers on products or services to your attention that are hoped to be of interest to you.

Do you agree to allow "loyaltycard" shop and other carefully selected companies and organizations to disclose such information?

� I Agree                                                 � I Disagree

I have read and understood the conditions of the Loyalty Card and the application is correct to the best of my knowledge. 

Signature

Date 

Loyalty card application form  in MSWord format.