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
Changes to existing card account Place Card #
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
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