Online Application

Personal Details - Please fill all required fields

Title*

Mr
Mrs
Miss
Ms

First Name*

Surname*

Gender*

Male
Female

Your date of birth*

DD

MM

YYYY

Street Address*

Suburb*

State*

Postcode*

Home Phone Number*

If you don't have a home phone, simply list N/A

Mobile Phone Number*

If you don't have a home phone, simply list N/A

Email address*

Important Information

a) Members must complete an application form supplying their details to receive a Rigters Rewards card.
b) Please allow up to 48 hours for your card to be activated before use.
c) Please see terms and conditions for full details of points accrual ratios.
d) You may use your accrued points partially or wholly at any time. Simply ask the checkout operator before making payment
e) Accrued points cannot be redeemed for cash.
f) This card remains the property of Queens Supermarkets (WA) Pty Ltd at all times.
g) Queens Supermarkets (WA) Pty Ltd reserves the right to withdraw the card and to terminate the Rigters Rewards program at any time

Do you wish to receive information regarding competitions, updates, promotional material and/or marketing via email*

Yes
No

I have read and agree to the terms and conditions.*

Yes
No