Country Card Sign Up Form. Country Mart

It's Fast and Easy as 1-2-3!

1. Fill out the application
form below and print this page, bring it to your local Country Mart Store. Your Country Mart associate will issue your Country Mart card immediately so you can start saving today!

2. Immediate Rewards!
Look for signs throughout the store identifying exclusive deals only available to our customers who use "The Country Mart Card."

3. Show
"The Country Mart Card" to the cashier at the beginning of each order and SAVE, SAVE, SAVE!

First Name:

MI:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

E-mail Address:

Social Security #:

(Optional for check cashing)

Birth Date:

(MO-DAY-YEAR, Example: 01-12-00)

Male/Female:

Number in Household
under Age 12:

Number in
Household:

I do not wish to receive coupons, special offers or other information.

Print this page, fill it out and bring it to your local Country Mart Store.

Sign up for Savings Today!

The Country Mart Frequent Shopper Program makes it easier for you to save and us to reward you for coming back.

• Automatic Grocery Savings

• Random Winners for Free Groceries

• Exclusive Holiday Discounts

• Special Mailings just for Card holders

• Automatic Entry for Drawings

• School Support