Al's -- Apply Online

Don't have a Value Plus card? Don't worry! Just fill out this simple Value Plus enrollment form and submit it and we'll make you a new Value Plus customer! Or, if you already have a card, but it needs replacing, or we have outdated information on you, you can use this form to bring us up to date so you won't miss any Value Plus rewards you may have coming!

Name *
Address *
City *
Zip Code *
Home Phone *
E-mail*

Is this: *

		Your first Value Plus card
		A replacement for a worn-out or lost card If so, please enter your old/existing Value Plus card number. This is the 11-digit number under the bar code on the back of the card, beginning with 4:
		A name change If so, please enter your old/existing Value Plus card number. This is the 11-digit number under the bar code on the back of the card, beginning with 4:
		An address change If so, please enter your old/existing Value Plus card number. This is the 11-digit number under the bar code on the back of the card, beginning with 4:

If you currently have a Value Plus card, please enter that card number here:

If your household has several cards with different numbers, please enter them here:

1	2
3	4

* Indicates required field

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