New loyalty card request form
1 - Personal data
2 - Confirm email
3 - Card issuing
Name:
*
Surname:
*
Gender:
*
Male
Female
Not specified
Phone number:
*
Telephone number:
City of residence:
*
Postal code:
*
Residence address:
*
Street number:
*
Preferred store:
*
Date of birth:
*
DD
DD
MM
MM
YYYY
YYYY
Discount code:
Consent to the
Regulation and data processing
*
Consent to the data processing for
direct marketing purposes (ver. 2024)
and
(ver. 2025)
(telephone, sms, mms, email, post)
Consent to the processing of data for
profiling purposes (ver. 2024)
and
(ver. 2025)
(evaluation of preferences, consumption habits, marketing surveys and statistics)
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*mandatory fields
