Mega Foods - Member Preferred Card Update Form

Mega Member
Information Changes and/or Card Requests

Have you moved?...Changed your name?...Need new cards?

What's the importance of updating my information?

This information is used for many different reasons:

So take a few minutes to do this now, it may come in handy later!

Current Mega Member Information

* Required

Name:*

Former Name (if applicable):

Address:*

Apt/Suite:

City:*

State:*

Zip:*

Primary Phone Number:*

Secondary Phone Number:

Email Address:

Mega Foods/Holiday Employee

Location:

NEW Mega Member Information if moving or have moved

Name:
Address:
Apt/Suite:
City:
State:
Zip:
Primary Phone Number:
Secondary Phone Number:

Effective Date of Changes:	(mm/dd/yyyy)

Card Requests (if applicable)

Request Mega Member Card Set
Member Number:


Additional Notes:

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Where to Shop

Mega Foods East
1201 S. Hastings Way - Eau Claire
715-836-8700

Mega Foods West
2615 N. Clairemont Ave - Eau Claire
715-836-6342

Mega Foods Chippewa
303 Prairie View Rd - Chippewa Falls
715-723-5232