Ukrop's Super Markets

(for new, first-time applicants only)
Privacy Statement

Become a member for savings and many other benefits, every time you shop!

To get your UVC card, just print this application and bring to the store. (Existing UVC program members, please use UVC Change of Address Form available at all Ukrop’s offices for new or
additional cards or key tags.)

Primary UVC Cardholder (please print)

Ms. Miss Mrs. Mr. Dr.

First Name:	MI	Last
Address:	Apt.#
City:	State:	Zip:
Home Phone:	Work Phone:
E-mail address:
Birth month:
# of Household Members:

Additional Cards/Key Tags

I would like to pick up additional card(s) or key tag(s) for other members of my household.
Please fill in names below. I would like an additional card for myself, the Primary UVC cardholder.
(key tags available only in store office)

I would like a card/key tags for household member #1

First: MI: Last:

I would like a card/key tags for household member #2

First: MI: Last:

By signing here , I ask that a Ukrop’s Valued customer card be issued as I have requested. I agree to allow Ukrop’s Super Markets, Inc. to record and use information about the products I purchase and to provide me with special offers and information by mail from Ukrop’s only.

Check this box, if you wish to receive no mail from Ukrop’s, but continue to save at check-out.

Signature: Date:

The UVC card is the property of Ukrop's Super Markets, Inc. Please use it every time you shop with us. It will be honored for all purchases subject to our policies for check cashing and the Ukrop's Valued Customer® program. For your protection, notify us if it is lost or stolen. As always, please let us know if you are dissatisfied for any reason with any product or service.

Ukrop's Valued
Customer Card

Contests

Discounts

UVC Card
Application