S A F E W AY C L U B C A R D A P P L I C AT I O N PLEASE COMPLETE…

 S A F E W AY C L U B C A R D A P P L I C AT I O N
 PLEASE COMPLETE AND SIGN THIS APPLICATION TO JOIN THE SAFEWAY CLUB. PRINT CLEARLY IN BLACK OR BLUE INK.
 NEW CARD APPLICATION
      New Member                                         New Member with Safeway SMARTCHECK
      (please complete Section 1 only)                   (please complete Sections 1 and 2)
                                                                                                                              INTERNAL USE
 CHANGES TO EXISTING CARD ACCOUNT                                                                                              Place Card #
                                                                                                                               Sticker Here

 Existing Club Card Number (required)
      Replacement Card                 Name/Address /Phone Update                  Add Safeway SMARTCHECK                             Bank or Driver's License Change Information
      (please complete Section 1)      (please complete Section 1)                 (please complete Sections 1 and 2)                 for Safeway SMARTCHECK Member
                                                                                                                                      (please tape a new voided check below,
      Add United or Alaska Airlines Account Number                                                                                    and complete Sections 1 and 2)
      (please complete Section 1)
                                                                                   Other
       Link cards, members of your household or a new card
       to an existing Club Card number (used to maintain
       participation in promotions and other programs)                       Existing Club Card Number (required)                             New Club Card Number to Link (required)



                                                                                                   Must be at least 18 years of age
                             SAFEWAY CLUB CARD                                                     Incomplete information may result in loss of sweepstakes prize or other offers
                                                                                                   *Required Information                                                                          SAFEWAY CLUB CARD CUSTOMER




  1
                                                                                                                                                                                                  AGREEMENT STATEMENT
                             Last Name*                                                                                 First Name*                                              M.I.                    We respect your privacy. Safeway does not sell or lease personally identifying
                                                                                                                                                                                                  information (i.e., your name, address, telephone number, and bank and credit
                                                                                                                                                                                                  card account numbers) to non-affiliated companies or entities. We do record
                                                                                                                                                                                                  information regarding the purchases made with your Safeway Club Card to
                             Street Address*                                                                                                                   Apt#                               help us provide you with special offers and other information. Safeway also
                                                                                                                                                                                                  may use this information to provide you with personally tailored coupons,
                                                                                                                                                                                                  offers or other information that may be provided to Safeway by other companies.
                             City                                                                                                State        Zip Code*                                           If you do not wish to receive personally tailored coupons, offers or other information,
                                                                                                                                                                                                  please check the box below. Must be at least 18 years of age.
                                                                                                                                                                                                         Check this box only if you DO NOT wish to receive personally tailored
                             Birthdate (month/day/year)                  E-Mail Address                                                                                                                  coupons or offers from Safeway. By checking this box, you will not be
                                                                                                                                                                                                         eligible to receive any special offers for which you might otherwise
                                                                                     If you forget to bring your Safeway Club Card with you,
                                                                                     we can link your card to your phone number.                                                                         qualify for through your use of your Safeway Club Card.
                             Home Phone

                                                                                     To earn miles include your United or Alaska Airlines Account Number
                             Airline Mileage Program Account Number                                                                                                                                                                                                     Date
                                                                                                                                                                                                  Applicant's Signature (must be signed to be valid)




                             SAFEWAY SMARTCHECKTM INSTRUCTIONS                                                                                                 Must be at least 18 years of age   SAFEWAY SMARTCHECKTM




   2
                             To obtain Safeway SMARTCHECK, you must tape your current pre-printed, VOIDED check to this application. This check will identify the checking
                                                                                                                                                                                                  CUSTOMER AGREEMENT STATEMENT
                             account from and to which electronic payments and/or refunds will be made. Upon approval, you will receive a letter in the mail notifying you when                           By signing this application/agreement and later using (or authorizing another
                                                                                                                                                                                                  person to use) my Safeway Club Card at Safeway retail stores, I agree to be obligated
                             your Card is ready for Safeway SMARTCHECK activation. Bring in your confirmation letter and your Driver's License or State I.D. Card to select your
                                                                                                                                                                                                  by the terms and conditions as set forth in the agreement which will be issued upon
                             Personal Identification Number (PIN) and activate Safeway SMARTCHECK.                                                                                                approval of this application. I authorize Safeway, its affiliates and subsidiaries to
                                                                                                                                                                                                  electronically debit the checking account identified here, or if appropriate, to credit
                            · To pay for groceries using Safeway SMARTCHECK, you MUST use your Club Card at checkout.
                                                                                                                                                           IMPORTANT NOTE:                        that account, to pay for purchases made and/or cash received using Safeway
                                                                                                                                                                                                  SMARTCHECK and my Safeway Club Card. I understand that the origination of such
                            · Phone number will not activate Safeway SMARTCHECK.                                                                            Please Tape VOIDED                    transactions from my account must comply with the provisions of U.S. law. The
                            · Allow four to six weeks for application processing. One Card per customer.                                                    check to application.                 authorization to complete transactions hereunder will remain in full force and effect
                                                                                                                                                             DO NOT submit a                      until Safeway receives written notification from me of its termination in such time and
                                                                                                                                                                Deposit Slip.                     manner as to afford it and my bank a reasonable opportunity to act on it. I hereby
                                                                                                                                                              A complete updated form is          represent and warrant that I have authority to make withdrawals from, and to
                       ®
                                                                                                                                                              required for any future bank        otherwise bind, this checking account. In the event my bank denies and returns any
    Now, link your             Driver's License Number or State I.D. Number                                                    State Issued                 account and/or routing changes.       electronic check to Safeway, I authorize Safeway to electronically re-present my check
Safeway Club Card and                                                                                                                                       Returned checks, along with the       for both the electronic check amount AND any returned check fee or electronic fund
                                                                                                                                                           returned check or electronic fund
your personal checking
                                                                                                                                                          transfer fees, may be electronically
                                                                                                                                                                                                  transfer fee as allowed by state law.
    account in one             Home Phone                                          Social Security Number                                                       presented to your bank.
   convenient Card!
                                                                                                                                                                                                  Applicant's Signature (must be signed to be valid)                    Date