First Name:

Middle Initial:

Surname:

Name to appear on card: (maximum of 25 letters including space)

Home Address:

Mobile Number:

E-mail:

Birthdate

Photo of the expired BDO - Laus Master Card:

Photo of any Government Issued ID:

Select Dealership:
BMW Premier Cars PampangaCarworld PampangaCarworld MarilaoCarworld MalolosCarworld TarlacCarworld SubicFUSO Carworld PampangaChevrolet PampangaChevrolet DagupanChevrolet Ilocos NorteChevrolet BaguioFord PampangaFord LibisFord SubicFord CabanatuanFord DagupanFord TarlacFord IsabelaFord Ilocos NorteFord Metro BaguioFoton Metro ClarkHaima Cars PampangaHaima Cars San FernandoHaima Cars DauHaima Cars UrdanetaHaima Cars CalasiaoHaima Cars BaguioHaima Cars BataanHaima Cars Ilocos NorteHaima Cars La UnionHyundai BaliwagHyundai BataanHyundai DagupanHyundai La UnionHyundai Ilocos NorteHyundai Trucks and Buses ClarkHyundai Trucks and Buses BaliwagKia PampangaKia BaliwagKia PangasinanKia ClarkKia MalolosKia IsabelaMazda CabanatuanMazda DagupanMazda PampangaMazda TarlacNissan BataanNissan ClarkSuzuki San FernandoVolkswagen PampangaCarmix Pampanga

By signing this form and providing my personal information, I expressly consent to the collection, processing, retention, disclosure and disposal of my personal data necessary for the execution of processes related to inquiries, applications and sales of services and products by the Company, including all other affiliates of the LausGroup of Companies, to which the Company belongs. I further expressly acknowledge that I am fully aware of my rights under Republic Act No. 10173 or The Data Privacy Act of 2012 and other relevant privacy laws which include, but are not limited to, the right to withdraw this consent, or revise, erase and prevent further use of my information.

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