First Name*
 
 
Last Name*
 
 
 
Company Name*
 
 
Job Title*
 
 
 
Email*
 
 
Telephone*
 
 
 
Membership number (if known)
 
 
 
 
 
 
 
Please select your EPOS provider*
 
 
If your EPOS is 'other' please specify
 
 
 
Do you have internet access in your till area?*
 
 
Are you already redeeming the National Garden Gift Card?*
 
 
 
Any questions or additional information?