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CLUB JAZA
Reward program application form.
Please fill out the application form to become a member of
Club Jaza
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* Indicates required question
Name
*
First and last name
Your answer
Gender
*
Your answer
Mobile Number
*
Your answer
ID/Passport Number
*
Your answer
Area of Residence
*
Your answer
Preferred Jaza Store For Collection
*
Your answer
Email Address
*
Your answer
*This information is regulated and protected by the office of Data Protection Controllers Act of Kenya.*By signing this form ,you consent to receive SMS and/or email correspondence from Jaza Supermarket; an opt-out option is provided.
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