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SuperGold/Veterans & GreyPower Membership Registration:

NZ Online Chemist is proud to offer all SuperGold Card and GreyPower Members 10% OFF all Retail Shop items
on this website (excludes Specially Priced Items). To be eligible, please fill in the following details, and we will send you
a special "Discount Code" that you must use in the "Voucher Code" box as you checkout. The delivery address of your
future purchases must match the address registered with your card provider.


Title:
First name:
Last name:
Date of birth:
Home address:
Postal address (if different):
City/town:
Country: New Zealand
Postal code:
Home phone number:
Mobile phone number:
Email address:
Membership program:
Membership card number:
Membership card expiry date:

By submitting this form, you give permission to us to double check your details with the card provider.