All about you - we need your details in order for us to send you your Club Mailings

Title	Mrs Miss Ms Mr Other   Male Female
First name(s)
Surname
Your address
Town
County

Club information - details to enable us to send you just the right information

If you are pregnant, please tell us your due date

Your baby’s birth date

Date of birth   Number*     Date of birth   Number* 1.     2.

*For multiple births, please provide one date of birth and indicate the number of children sharing that birth date.

Are you a Clubcard member?

Yes		Please type your number below, as it helps us speed up your application
No		By completing the rest of the application form, you will become a Clubcard member

Contact Details - we’d like to email you news of relevant offers and occasionally call you for market research purposes

Preferred contact number				(home, work or mobile)
Email address

Household details - so we can send you relevant information and coupons for your household

How many people are there in your household? (including yourself)

Your date of birth         This may be used for the security of your account.

Please enter the ages of the other people in your household (if you have a child under 1, please enter 0)

Age       Age     Age     Age     Age

Dietary details - we’d like this information so we only send you coupons relevant to your lifestyle

Please tick any of the following if you want to receive offers and coupons from us

Coeliac Diabetic Vegetarian Teetotal

If you do not indicate an interest in any of the above we’ll still send you great offers on the range of products available at Tesco.

Data Protection - for you to choose what we contact you about

We would like to reassure you that your details are safe with us and will never be released to companies outside Tesco Group for their marketing purposes.

We will use your details in accordance with our Clubcard Data Protection Statement. For further details, pick up a Clubcard Application Form in store, or call our Clubcard Helpline on 00800 00 59 16 88.

From time to time, we would like to contact you with offers and information about products and services of interest to you and your family. If you tick the boxes below, we will NOT be able to send you these great offers and information.

	If you do not want to receive offers and information about Tesco products and services, please tick this box
	If you do not want Tesco to send you offers and information about the products and services provided by our partners, please tick this box
	If you do not want to be contacted by Tesco for customer research purposes, please tick this box

If you are an existing Clubcard member, your selections above will supersede any previous preferences.

	I agree to the use of my information and stated above and in the Clubcard Data Protection Statement.