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Gold Star Member Pre-registration Form

Primary Card

*  …Required.
**…Minimum One telephone number required.
Nearest Warehouse*
Primary Member Name*
First Name

Last Name
Address*
Zip Code
Prefecture (Auto Input)

City/Town/Ward (Auto Input)

Address 1

Address 2

Home Phone Number**
Mobile Phone Number**
Email Address*
Re-enter Email Address*
Date of Birth*
Year:Month:Day:
Sex*
Sex
ID*
ID Type
Id Type
ID Number [The social security number is not acceptable]

Household Card (Optional) *Spouse / Domestic Partner

A free Household card is available to a Primary cardholder’s spouse, domestic partner, or immediate family member over the age of 18 and living at the same residential address. Household cardholders will be asked to present proof that they live at the same address as the Primary cardholder.

Request Free Household Card


Please check the following item for confirmation.

I did not cancel Costco membership within last 12 months.

Submission of this application by clicking the "Accept" button shown below constitutes acceptance of Costco's Member Privileges and Conditions, and Privacy Statement.

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