Frequent Customers Club

Senior Citizen Card

Please print out this form and return it to your local McDonald's restaurant.

Frequent Customers Card Senior Citizen Card
First Name:
Last Name:
Date of Birth:	/ /
Address:
City:
State:
Zip Code:

How often do you frequent this McDonald's?
	Once a week Twice a month Monthly
Was this visit the most convenient because:
	Live in town Work in town Shopping Other