MEMBERSHIP APPLICATION

Premium Business

Primary Cardholder Information

Mr. Mrs. Ms.

Last Name First Name Middle Name Sux

Name:
Day Month Year

Birthday:
No. Street Subdivision/Barangay City/Municipality/Province

Home Address:

Mobile No.: Landline: Email:

Occupation:
If Business Application

Citizenship:
Business Name:
Filipino
Others, please specify country
Business Type: Code:

Business Address:
How should we communicate with you?
Email Mail
Phone No.:
Mobile Home Phone

Business Email:

Extension Cardholder Information

Relationship to Primary Cardholder:

Mr. Mrs. Ms.

Last Name First Name Middle Name Sux

Name:
Day Month Year

Birthday:
No. Street Subdivision/Barangay City/Municipality/Province

Home Address:

Mobile No.: Landline: Email:

Occupation: Citizenship: Filipino Others, please specify country

I certify that all the info above are true and correct.

Signature of Primary Cardholder Date Form No.:

 TERMS AND CONDITIONS BUSINESS EXTENSION
We are glad to welcome you as the newest member of the Landers Superstore
family. Here are your membership privileges and conditions: Extension Cardholder Information
1. Membership: Any individual above 18 years of age is qualified to apply Relationship to Primary Cardholder:
for membership. Membership application is bound by the rules of
Landers Superstore, which could be altered without prior notice. Mr. Mrs. Ms.
Landers Superstore also reserves the right to refuse membership to any
applicant. Membership may be nullified without notice or cause. Last Name First Name Middle Name Sux

2. Membership Cards and Fees: The membership fee is covered for one Name:
(1) year from the date of application of the Primary cardholder. The Day Month Year
membership card will expire on the anniversary date of the Primary
Birthday:
cardholder, as well as its Extension. The card is valid at any Landers
Superstore. For security purposes, you will be requested to show your
No. Street Subdivision/Barangay City/Municipality/Province
membership card upon entering Landers Superstores. You will likewise
be requested to show your membership card when paying at the Home Address:
register. Lost or stolen membership cards should be reported
immediately to the Landers Superstore Membership Department. A Mobile No.: Landline: Email:
P100 fee will be charged for the replacement of each card. Membership
may be terminated at the discretion of Landers Superstore. All member-
Occupation: Citizenship: Filipino
ship cards are non-transferable, remain as property of Landers
Superstore and must be surrendered upon request. Others, please specify country

3. Renewal, Revision, or Deletion of Cards: The primary cardholder is

responsible and authorized for the renewal or any changes , including
deletion, of the membership. A notification will be sent to you for your
upcoming renewal each year. However, all primary cardholders must Signature of Primary Cardholder Signature of Extension Date
pay the renewal fee, which can be done at any Landers Superstore.
Upon receipt of renewal fees, your membership will automatically be
extended for an additional one (1) yearand your membership card will
be replaced by a new one.
Extension Cardholder Information
4. Termination of Membership: You may discontinue your membership
any time and we will refund your membership fee. To terminate your Relationship to Primary Cardholder:
membership, the Primary cardholder should submit to the Landers
Mr. Mrs. Ms.
Superstore Membership Department a written termination notice
together with the membership card, official receipt and any valid Last Name First Name Middle Name Sux
identification card with photo. The refund will be pro-rated based on the
number of months remaining in your current annual membership.
Name:
5. Payment: Payment can be made via cash, debit card or credit card Day Month Year
authorized by Landers Superstore. Birthday:

6. Return or Refund: The Landers Superstore member, his extension, No. Street Subdivision/Barangay City/Municipality/Province
and Landers Superstore agree that return or refund is subject to the
following rules: Home Address:

. Replacement or exchange will be done in the Landers Superstore Mobile No.: Landline: Email:

. where the item was purchased.

All defective merchandise for replacement or exchange must be Occupation: Citizenship: Filipino
returned within seven (7) days from the date of purchase, along with
Others, please specify country
. the original Landers Superstore sales receipt.
Non-food merchandise must be returned complete with original

. packaging, manual and factory sales intact.

Undergarments are not returnable nor are they exchangeable. Items
considered as Service Center are not refundable and will be
returned to an authorized Service Center to repair under Signature of Primary Cardholder Signature of Extension Date

. manufacturers warranty.
Replacement or exchange of perishable items is only valid within 24

. hours from date of purchase.

Food items to be returned should at least be 75% intact.
Extension Cardholder Information
7. Warranty Policy: Landers Superstore honors all manufacturer's
warranties with respect only to locally-sourced items and/or products Relationship to Primary Cardholder:
manufactured within the Philippines. With respect to foreign-sourced Mr. Mrs. Ms.
and/or imported items, the warranty of Landers Superstore shall be
limited.The Landers Superstore Warranty Policy does not apply to any Last Name First Name Middle Name Sux
product, or part thereof, which has been damaged through electrical
voltage fluctuation, improper installation, misuse, alteration, attempts of Name:
repair, neglect, accident, removal/defacement of factory seals or serial
Day Month Year
numbers, damages from fire, flood, and wind or water.
Birthday:
8. General Policies: Landers Superstore promotes family bonding thats
why members are welcome to bring their children and guests. However, No. Street Subdivision/Barangay City/Municipality/Province
only members are allowed to purchase merchandise using his/her
Home Address:
membership card. Responsible parenting is also encouraged inside the
superstore; children should not be left unattended. Opening of
Mobile No.: Landline: Email:
merchandise before purchase is not permitted. Members are
responsible for any opened or damaged merchandise by their
guests, children or themselves. Landers Superstore reserves the Occupation: Citizenship: Filipino
right to inspect backpacks, diaper bags or briefcases.
Others, please specify country
To ensure that you have been charged correctly for the merchandise received,
all receipts will be verified upon leaving the superstore. Landers Superstore is
not responsible for any damage or loss caused, directly or indirectly, by defects
in the merchandise manufactures or sold by other companies. Signature of Primary Cardholder Signature of Extension Date
Landers Superstore does not assume the obligation of a depository or
safe-keeper of any vehicle and any content or part thereof while inside our
parking area. Landers Superstore members solely assume all risks to his/her
vehicle and its content when using the parking area. Therefore, Landers
Superstore is not responsible for any damage or loss to your vehicle while at the
Membership Fee
For Landers Internal Use
parking area.
Date: Premium P800
By submitting this membership application form, the applicant affirms that
he/she has read and understood the terms and conditions and gives his Method of Payment: Business P1000
unqualified conformity to these terms and conditions of membership.
Amount Paid: Extension P400

Membership Card No.:

Remarks:

Signature of Primary Cardholder Date CDA Code: