Bordine's. - "Bordine Card" Application Form


	Become a "Bordine Card" member Today!
	It's Free and Loaded with Benefits

	Print and fill out this form prior to shopping at Bordine's. Fill out this form prior to shopping at Bordine's. Simply give the completed form to the cashier and you start earning benefits immediately! Please, one "Bordine Card" per household


Required Information
Name:
Additional User:
Address:
City:		State:		Zip:
Home Telephone:	( ) —
Email:
Date of Birth:	/ /
	Month Day Year


Requested Information
Gender: Please circle one		Male	Female
Type of Gardener: Please circle one		Beginner	Moderate	Avid
I shop at Bordine's: Please circle all that apply		Spring	Summer	Fall	Christmas

PRIVACY POLICY: Bordine's will not distribute or sell your personal information.
We value your privacy.

Cashier Instructions:

Take new "Bordine Card"

Affix sticker to form in box below

Give new card to customer

Drop form in Daily Records