2024 KCPEx Loyalty Card Membership Form

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Retail & Estore Teams, kindly secure the following information from the customer and fill out this Google Form for each new DIGITAL KCPEx card.

The digital KCPEx card will be edited and emailed to the customer by Kali (for now) after the information and payment have been secured by the Retail staff/Estore and the request for card creation has been forwarded by the staff to Kali. You may just email me the First Name, Last Name, and Membership Type of the customer, then I will be the one to assign the Membership Card Number and reflect it on the digital card and on the form.

Each Kaibigan Card and PEx card will bear only the Membership Card Number. The Membership Card Numbers will be reflected this way: "Card type" 2024-Number. Ex: KC 2024 0001..., PEX 2024 0001...

Email *

First Name *

Last Name *

Membership Type *

Kaibigan Card

Pastors' Exclusives

Date of Application *

YYYY

Branch where Customer Applied *

Membership Card Number

Membership Status *

NEW Member (KC: Php 250 | PEx: Php 200)

Renewal for Existing Member (KC/PEx: Php 200)

Lost Card, therefore Renewed Application (KC/PEx: Php 200)

Payment Type *

Cash

Card Payment (credit/debit)

GCash

PayMaya

Other:

Valid until *

YYYY

Sex *

Female

Male

Civil Status *

Single

Married

Others

Birthday *

YYYY

Occupation *

Company/School Name *

Mailing Address *

Email Address *

Mobile Number *

Religious Affiliation *

Name of Church *

Submit

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