Carrs Safeway Club Card – Fill Out and Use This PDF

Bank or DriverÕs License Change Information for Carrs SM ARTCHECK M ember

(please t ape a new voided check below, and complet e Sect ions 1 and 2)

New Club Card Number to Link (required)

CARRSPLUS/SAFEWAY CLUB CARD CUSTOMER AGREEMENT STATEMENT

We respect your privacy. Carrs does not sell or lease personally identifying information (i.e., your name, address, telephone number, and bank and credit card account numbers) to non-affiliated companies or entities. We do record information regarding the purchases made with your Carrs Plus/Safeway Club Card to help us provide you w ith special offers and other information. Carrs also may use this information to provide you w ith personally tailored coupons, offers or other information that may be provided to Carrs by other companies. If you do not wish to receive personally tailored coupons, offers or other information, please check the box below. M ust be at least 18 years of age.

Check this box only if you DO NOT w ish to receive personally tailored coupons or offers from Carrs. By checking this box, you w ill not be eligible to receive any special offers for w hich you might otherw ise

qualify for through your use of your Carrs Plus/Safew ay Club Card.

2

To obtain Carrs SM ARTCHECK, you must tape your current pre-printed, VOIDED check to this application. This check will identify the checking account from and to which electronic payments and/or refunds will be made. Upon approval, you will receive a letter in the mail notifying you when your Card is ready for Carrs SM ARTCHECK activation. Bring in your confirmation letter and your DriverÕs License or State I.D. Card to select your Personal Identification Number (PIN) and activate Carrs SM ARTCHECK.

CARRS SM ARTCHECK™

CUSTOMER AGREEMENT STATEMENT

By signing this application/agreement and later using (or authorizing another person to use) my Carrs Plus/Safeway Club Card at Carrs retail stores, I agree to be obligated by the terms and conditions as set forth in the agreement which will be issued upon approval of this application. I authorize Carrs, its affiliates and subsidiaries to electronically debit the checking account identified here, or if appropriate, to credit that

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Now, link your

Carrs Plus/Safew ay Club Card and your personal checking account in one convenient Card!

¥ To pay for groceries using Carrs SMARTCHECK, you MUST use your Club Card at checkout .

¥Phone number will not activate Carrs SMARTCHECK.

¥Allow four to six weeks for application processing. One Card per customer.

I M PORTAN T N OTE:

Please Tape VOIDED check to application.

DO NOT submit a

Deposit Slip.

A complete updated form is required for any future bank account and/or routing changes. Returned checks, along w ith the returned check or electronic fund transfer fees, may be electronically presented to your bank.

account, to pay for purchases made and/or cash received using Carrs SMARTCHECK and my Carrs Plus/Safeway Club Card. I understand that the origination of such transactions from my account must comply with the provisions of U.S. law. The authorization to complete transactions hereunder will remain in full force and effect until Carrs receives written notification from me of its termination in such time and manner as to afford it and my bank a reasonable opportunity to act on it. I hereby represent and warrant that I have authority to make withdrawals from, and to otherwise bind, this checking account. In the event my bank denies and returns any electronic check to Carrs, I authorize Carrs to electronically re-present my check for both the electronic check amount AND any returned check fee or electronic fund transfer fee as allowed by state law.