Russ's Market
Privilege Plus


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Privilege Plus Card Application Form

You're on your way to Privilege Plus savings! Fill out the from below and click on "Make a Printable Version." Print your application and bring it in to your nearest Russ's Market. You'll receive key tags and a card so you can begin saving immediately.

Card Holder Information:
Last Name:
First Name:
   MI
Address:
   Apt.
City, State, Zip:
 ,
Phone Number:
 () -
E-mail Address:
Birthdate:
 -- (mm/dd/yy)
Primary Card:
If primary household card was requested earlier, please enter that number here so we can link. (starts with "499")

The information which I provide you and the records of the products which I purchase will not be sold or given to any third party.
  


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