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Primecard Membership Application (New Members Only)
FREE 1-year membership (Save Up to 50% on your purchases) Members will receive bi-monthly directories, newsletters and special offers. Complete the form below and submit. Or to apply by mail or fax, click here to download the form in PDF format and send it to the address or fax number listed on the form. Or to apply by phone, call Customer Service, 1-800-444-8872.
Applicant Information
Promo Code:
(Enter promo code if applicable, to activate special offer or promotion)
Referred By:
(If applicable, enter the Primecard account number of the cardholder you were referred by)
First Name:
Middle initial:
Last Name:
Date of Birth: Month January February March April May June July August September October November December - Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -
Email:
Home Telephone:() - -
Mailing Address: -
City: State: AL AK AZ AK CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SD TN TX UT VT VA WA WV WI WY AS FM GU MH MP PW PR VI AE AA AE AE AE AP ZIP/Postal Code:
Mother's Maiden Name:
Employer:
Work Telephone:() - -

Additional User (Optional)

First Name:

MI:

Last Name:

Monthly Credit Card Payment Authorization

Card Type:  Visa Mastercard American Express Discover

Credit Card #:

Expiration Date:  Month January February March April May June July August September October November December Year 2012201320142015201620172018201920202021

By checking this box, I state that I have read, and agree to, Primecard 's Account Application Terms and Conditions. Upon credit approval, you should receive your Primecard card within 10 business days.