JTA Thank You Card Sign Up Form
Thank You for choosing JTA Supermarkets! Please note that this form is for NEW card sign ups only. For replacement cards please visit any one of our branches. Please call 652-3611 OR email jtathankyou@jtasupermarkets.com for more information.
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FIRST NAME *
MIDDLE NAME
LAST NAME *
GENDER *
TITLE
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ADDRESS LINE 1 *
ADDRESS LINE 2
CITY *
CONTACT NUMBER(S) (Home, Cell, Work) *
EMAIL ADDRESS *
IDENTIFICATION NUMBER (National I.D., Driver's Permit, or Passport) *
DATE OF BIRTH (mm/dd/yyyy) *
MM
/
DD
/
YYYY
OCCUPATION
PREFERRED BRANCH FOR CARD PICK UP *
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