| Title: |
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| Initials: |
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| First Name: |
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| Surname: |
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| ID No: |
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| Area: |
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| Which is your closest Meltz Store: |
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2. Contact Information
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| Physical Address: |
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| Suburb: |
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| Province: |
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| Postal Code: |
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| Telephone Work: |
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| Telephone Home: |
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| Telephone Cell: |
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| Fax: |
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| Email: |
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| Preferred ways to receive information: |
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Sms |
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Email |
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Post |
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3. Loyalty Customer Information
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| Income Group: |
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| Education: |
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| Life Stage: |
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| Spouse Name: |
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| Spouse Birthday: |
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| Wedding Anniversary: |
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| Employment: |
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| Name of company you are employed by: |
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| Job Title: |
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| Language: |
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| Gender: |
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| Group: |
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| Age: |
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4. Please advise us of any changes of address or other details or if your card is lost/stolen
either in store, or contact 021 7139025, or via email rewards@meltzstores.co.za. Please note
that once a card is replaced, the original card, if found, will no longer be active or work.
5. I have read and understood the Terms & Conditions for the Meltz Rewards Club
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