s2d Grocery Delivery Membership Form

IMPORTANT!

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Please visit our office for validation of your registration application and to recieve your lifetime membership card, which you're going to use at the later time. thank you

Application Form
Please take a moment to fill up the following items.

1.  First Name:

2.  Last Name:

3.  Middle Name:

4.  E-mail Address: (REQUIRED)

5.  Complete City Address:

6.  Cell Phone Number:

7.  Phone Number:

8.  What is the best time to reach you? (eg. 2-5pm)

9.  What is the best day to reach you? (eg.Mon., Wed.& Fri.)

10.  Preffered grocery store? (eg. SM Supermarket)

11.  Special Instructions for your location: (eg. land marks, gate color, etc.)

12.    I agree and fully aware of the terms, conditions and policies of using this service.