Diners Club South Africa – Personal Card Services

Personal Card

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Application Form

YES, I wish to join Diners Club Connoisseurs.

Put us to the test! Your first six months’ membership of Diners Club Connoisseurs is free. Thereafter the annual membership is R59 which will be debited to your Diners Club card.

Once you are a member you will receive a range of quality products throughout the year.

Membership is 100% guaranteed.

Tell us about yourself:
Compulsory fields are indicated with an asterisk (*)
COFFEE CORNUCOPIA
Choose your grind:
Choose your frequency:
Each Coffee package includes 6 packs of coffee, but you can select to receive additional packages (6 packs). E.g. If you indicate 1 extra package, you will receive 12 packs of coffee.
Please indicate extra quantity:

OLIVE OIL OBSESSION
Choose your selection:

* FIRST NAME
* SURNAME
* INITIALS
* TITLE
*ID NUMBER:
* TELEPHONE (HOME)
TELEPHONE (WORK)
FAX NUMBER
* MOBILE NUMBER
* E-MAIL
* DELIVERY ADDRESS
* POSTAL CODE
* POSTAL ADDRESS
* POSTAL CODE
Your Payment Details
* DINERS CLUB CARD NO.
* CVV NO	(last 3 digits on back of card)
* EXPIRY DATE
	To help us distinguish between information submitted by individuals and those automatically entered by software robots, please type the squiggly letters shown here into the box below.

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Application Form

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