Current Membership # (if applicable) ________________________________________________________________________
Last Name __________________________________ First Name _____________________________ MI _____ Sex
F M
Mailing Address _________________________________________________________________________________________
City ________________________________________________ State ____________________ ZIP Code _________________
Phone # _________________________________ Market Code
(BJ’s use only) ___________________
Email ___________________________________________________________________________
Driver’s License # ____________________________________________ State _____________________________________
If you choose to receive the second Household Card, please complete the following:
Last Name ___________________________________ First Name _________________________________ MI ___________
_____________________________________________
Primary Signature —
I understand that I am responsible for any checks and actions of the second Cardholder.
Please choose your method of payment. (Sales tax may be added. Make checks payable to BJ’s Wholesale Club, Inc.)
Check My BJ’s Perks
®
Mastercard
®
Mastercard
®
American Express
®
Discover
®
Network Visa
®
Credit Card Account #__________________________________________________ Expiration Date ___________ Total Charge____________
BJ’s Use Only
BJ’s Sales Representative’s Signature: __________________________________________________________________ Club # __________
All applications are sent to our Home Office; processing takes approximately 3 – 4 weeks.
SPECIAL SAVINGS JUST FOR EMPLOYEES OF
To qualify for this offer, please:
1. Complete this application in full and return it to your Organization Rep at the address below. Please include a check or credit card
payment for the full amount.
2. New Members: Your Membership Activation letter will arrive in 3 – 4 weeks. Bring it, along with a photo ID, to the Member Services
Desk at a Club near you to receive your Membership Card.
3. Renewals: Enter your Membership Number in the space provided below. Your current Membership Card will be renewed.
Organization Rep: ______________________________________ Contact Number: ________________________________________
Offer Expires: _____________ Address: ____________________________________________________________________________
(Required for check-writing privileges)
(Note: Household Cardmember must reside at
the same address as the Primary Cardholder.)
Date of Membership Purchase
/ /
Month Day Year
Plus, every BJ’s Primary Member receives a Second Card for a household member at no additional charge. New Members receive a $50 Restaurant.com card.
Two Great
Membership Offers
BJ’s INNER CIRCLE
®
MEMBERSHIP — Just $40*
Save $15 off the $55 annual Membership fee —
PLUS get 1 bonus month FREE
BJ’s PERKS REWARDS
®
MEMBERSHIP — Just $80*
Earn 2% back on most BJ’s purchases
Save $30 off the $110 annual Membership fee —
PLUS get 1 bonus month FREE
or
All BJ’s Memberships are subject to BJ’s current Membership Terms, ask in-Club or go to BJs.com/terms.
Choose Membership Level: BJ’s Inner Circle
®
Membership BJ’s Perks Rewards
®
Membership
Learn more about My BJ’s
Perks
®
Mastercard
®
by
visiting BJs.com/mybjsperks
Membership Expiration and Renewals: The month and year in which your Membership expires appear on your register receipts and on your “My Account” page on BJs.com.
Your Membership expires on the last day of the month and year shown. Paid Memberships renewed within two months after expiration will be extended 12 months from the
expiration date. Paid Memberships renewed more than two months after expiration will be extended for 12 months from the last day of the month of renewal.
*BJ’s Inner Circle® Membership fee is regularly $55; BJ’s Perks Rewards® Membership fee is regularly $110. This offer may not be combined with other offers, is not redeemable for cash or transferable, is not available online
or in-Club, and is good for new Members and current Members renewing before their expiration date only. Limit one offer per household. Photo identification required when applying for Membership. Plus state and local
taxes where applicable or required by law.
My BJ’s Perks® Program is provided by BJ’s Wholesale Club, Inc., and its terms may change from time to time. Some exclusions may apply. Visit BJs.com/perksterms for Program Terms.
My BJ’s Perks® Mastercard® is issued by Comenity Capital Bank, pursuant to a license by Mastercard International Incorporated. Mastercard is a registered trademark of Mastercard International Incorporated.
©2018 BJ’s Wholesale Club, Inc.
21454818
RENEWAL MEMBERS !! SUNY Poly Tech
400 River Rd Rear, Utica, NY 13502 Attn: Susan F.C.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
