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Online Application
Online application form for the Rigters Rewards program
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
Postal Address
*
Suburb
*
State
*
WA
ACT
NSW
NT
QLD
TAS
VIC
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