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AMERICARNA MEMBERSHIP APPLICATION

First Name *
Surname *
Date of Birth *
Month
Year
Postal Address *
Post Code *
Phone *
Mobile
Email

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To keep you informed about exclusive features and benefits of your Americarna Membership we will keep your email address on file. You have the right to update or correct the information we hold.

If you DO NOT wish to receive information from AmeriCARna please indicate by ticking this box.

Shell Card Application
tick if you wish to apply

Shell CardPlus Application Form (1.1 MB - pdf)

If applying, please print and complete your
CardPlus application form and return to:
Americarna NZ Ltd
PO Box 4234
NEW PLYMOUTH 4340
DECLARATION
for all applicants *
  • I confirm that the foregoing information is true and complete
  • I understand the Americarna NZ Ltd reserves the right to decline any applications
  • I have read and understood the Terms and Conditions of this account application and agree to be bound by them upon acceptance of this application.

Pursuant to the Privacy Act 1993 the following has been bought to my attention: This form collects personal information about me for the purposes of providing a membership account and administration of that account and for the purposes of providing ongoing information about our products and services. The intended recipient of the information is Americarna NZ Ltd, PO Box 4234 New Plymouth 4340. Failure to provide this information may result in my application being declined. I have rights of access to, and may request the correction of personal information about me held by Americarna NZ Ltd.

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