Loyalty Card Application Form

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Loyalty Card Application Form
Start saving on your shopping today by becoming one of our loyalty
customers. Please complete the form in BLOCK CAPITALS and hand over to our Information Desk staff
for your new Langlands loyalty card.
MR/MRS/MISS/OTHER
FIRST NAME
SURNAME
ADDRESS 1
ADDRESS 2
ADDRESS 3
POST CODE
PHONE
MOBILE
EMAIL
WE ONLY INFORM CUSTOMERS OF OUR LOYALTY OFFERS AND EVENTS BY EMAIL.
PLEASE CIRCLE ‘NO’ IF YOU DO NOT WISH TO RECEIVE OUR EMAILS.
LOYALTY NO.
L
O
Y
RECEIPT NO.
RECEIPT NO.
RECEIPT NO.

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