Registration Form

REGISTER YOUR SIM

Phone number*

First name*

Last name*

Date of birth (DD/MM/YYYY)*

/ /

E-mail (optional)

Street (domicile address) *

Number*

Box (optional)

Postal code*

City*

I accept the general conditions and the privacy conditions of Carrefour Belgium NV.

Register your card with the activation code you received

Phone number*

Personal activation code*

REGISTER WITH ID

REGISTER YOUR SIM

Phone number*

I accept the general conditions and the privacy conditions of Carrefour Belgium NV.

REGISTER YOUR SIM BY DOING AN ONLINE RELOAD

Phone number*

Amount of the reload*

Payment method*

First name*

Last name*

Date of birth (DD/MM/YYYY)*

/ /

Cardholder's place of birth*

E-mail (optional)

I accept the general conditions and the privacy conditions of Carrefour Belgium NV.