Safeway Application by CrisLapuz

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									Safeway Club Card appliCation
Please comPlete and sign this aPPlication to join the safeway club. Print clearly in black or blue ink.

New card application
       New Member

                                                                                                                   INTERNAL USE
Changes to existing card account                                                                                    Place Card #
                                                                                                                    Sticker Here
Existing Club Card Number (required)

       Replacement Card                 Name/Address/Phone Update

       Add Alaska Airlines Mileage Plan or
       United Mileage Plus® Account Number

       Link cards, members of your household or a new card
       to existing Club Card(s) number (used to maintain
       participation in promotions and other programs)           Existing Club Card Number (required)                        New Club Card Number to Link (required)

                                                                 Additional Existing Club Card Number (optional)

                                                              Must be at least 18 years of age
                                                              Incomplete information may result in loss of sweepstakes prize or other offers
Safeway Club Card                                             *Required Information                                                              Safeway Club Card Customer
                                                                                                                                                 Agreement Statement
                                                                                                                                                 We respect your privacy. Safeway does not sell or lease personally identifying
Last Name*                                                                    First Name*                                             M.I.
                                                                                                                                                 information (i.e., your name, address, telephone number, and bank and credit card
                                                                                                                                                 account numbers) to non-affiliated companies or entities. We do record information
                                                                                                                                                 regarding the purchases made with your Safeway Club Card to help us provide you
Street Address*                                                                                                      Apt#                        with special offers and other information. Safeway also may use this information
                                                                                                                                                 to provide you with personally tailored coupons, offers or other information that
                                                                                                                                                 may be provided to Safeway by other companies. Missing or inaccurate information
                                                                                                                                                 will limit our ability to provide you with custom offers. If you do not wish to receive
City                                                                                     State       ZIP Code*                                   personally tailored coupons, offers or other information, please check the box below.
                                                                                                                                                 Must be at least 18 years of age.

Birthdate (month/day/year)             E-mail Address*                                                                                                  Check this box only if you DO NOT wish to receive personally tailored
                                                                                                                                                        coupons or offers from Safeway. By checking this box, you will not be
                                                    If you forget to bring your Safeway Club Card with you,                                             eligible to receive any special offers for which you might otherwise
                                                                                                                                                        qualify through your use of your Safeway Club Card.
Home Phone                                          we can link your card to your phone number.

                                                    To earn miles, include your Alaska Airlines Mileage Plan or
Airline Account Number                              United Mileage Plus® Account Number.                                                         Applicant’s Signature (must be signed to be valid)                  Date

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