PRIVILEGE CARD APPLICATION FORM
Please complete all the fields in this form and click submit to apply for the
Pantiles Privilege card
Title
Mr
Mrs
Miss
Ms
Dr
Forename
Surname
Date of birth:
(Date/Month/Year)
Address
Postcode
Telephone
Email
Privacy option
Tick this box if you DO NOT want to be sent information from Pantiles.
NOTE: your details will not be passed to any 3rd party.
Terms & Conditions
Tick this box if you AGREE to the
terms & conditions
.
Your form will not be processed unless you tick this box.
Please note: your card is valid for purchases from Pantiles Nurseries only – it is not valid for money spend on landscape or design services, or on any products already discounted. Please see our
terms and conditions
for more information.