Retail use only. Please complete this application form below and issue your customer with a rewards card instantly.
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Card Number: (required) Please enter a valid 16 digit card number: Merchant Number: (required) Please enter your merchant number: Store Name: Staff Name: Full Name: (required) Please enter your full name: Date of Birth: (required) Please enter a valid date of birth (DD/MM/YYYY): (eg: 31/12/1979) Address: (required) Please enter your address: Suburb: (required) Please enter your suburb: State: (required) Please enter your state: Postcode: (required) Please enter your postcode: Phone Number: Mobile: (required) Please enter your mobile number: Email address: (required) Please enter a valid email address: Replacement Card / Link Card: Lost Card (enter personal details above) Damaged Card (enter card number below) Link Card (enter both card numbers below) Damaged Card / Primary Card Number: Secondary Card Number:
