{"id":257,"date":"2020-03-02T23:45:12","date_gmt":"2020-03-02T18:15:12","guid":{"rendered":"http:\/\/mleczkobakery.com\/?page_id=257"},"modified":"2021-05-19T20:32:47","modified_gmt":"2021-05-19T15:02:47","slug":"mleczko-card","status":"publish","type":"page","link":"https:\/\/mleczkodelikatesy.com\/en\/mleczko-card\/","title":{"rendered":"mleczko card"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.9.2&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#E02B20&#8243; background_image=&#8221;https:\/\/mleczkodelikatesy.com\/wp-content\/uploads\/2021\/03\/menyu_img.jpg&#8221; background_blend=&#8221;overlay&#8221;][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.9.2&#8243; _module_preset=&#8221;default&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.9.2&#8243; _module_preset=&#8221;default&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.9.2&#8243; _module_preset=&#8221;default&#8221;][et_pb_text _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<div class=\"container-fluid front-page-section\">\n<div class=\"row\">\n    <div class=\"col-xs-12 col-md-12\">\n\n<div class=\"loyalty-content\">\n\n<h4>Mleczko Loyalty Card Application Form<\/h4>\n\n<p>Fill out the form below. You will get a loyalty card and become a member of our loyalty program.<\/p>\n\n<p>The form can also be printed and filled deliver to one of our stores.<\/p>\n\n<p>* fields are required<\/p>\n\n<form name=\"mleczko-register-form\" method=\"post\" action=\"\">\n\n<div class=\"form-table\">\n\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>First name: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[first_name]\" id=\"mleczko_first_name\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Surname: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[last_name]\" id=\"mleczko_last_name\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Address  ( flat\/building number, street ): *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[address]\" id=\"mleczko_address\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Town: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[town]\" id=\"mleczko_town\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Country: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[country]\" id=\"mleczko_country\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Post code: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[post_code]\" id=\"mleczko_post_code\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Date of Birth: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[dob]\" id=\"mleczko_dob\" value=\"\" class=\"regular-text form-control\" placeholder=\"MM\/DD\/YYYY\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Telephone No.: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[telephone]\" id=\"mleczko_telephone\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Mobile No.: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[mobile]\" id=\"mleczko_mobile\" value=\"\" class=\"regular-text form-control\" placeholder=\"+44 aaaa bbb ccc\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>E-mail Address: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[email]\" id=\"mleczko_email\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>E-mail Address (verify): *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[email_two]\" id=\"mleczko_email_two\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>reCaptcha verification:<\/label><\/div>\n        <div class=\"col-sm-7 \"><i><p class=\"cptch_block\"><span class=\"cptch_wrap cptch_math_actions\">\n\t\t\t\t<label class=\"cptch_label\" for=\"cptch_input_48\"><span class=\"cptch_span\">&#110;ine<\/span>\n\t\t\t\t\t<span class=\"cptch_span\">&nbsp;&#43;&nbsp;<\/span>\n\t\t\t\t\t<span class=\"cptch_span\"><input id=\"cptch_input_48\" class=\"cptch_input cptch_shortcode\" type=\"text\" autocomplete=\"off\" name=\"cptch_number\" value=\"\" maxlength=\"2\" size=\"2\" aria-required=\"true\" required=\"required\" style=\"margin-bottom:0;display:inline;font-size: 12px;width: 40px;\" \/><\/span>\n\t\t\t\t\t<span class=\"cptch_span\">&nbsp;=&nbsp;<\/span>\n\t\t\t\t\t<span class=\"cptch_span\">17<\/span>\n\t\t\t\t\t<input type=\"hidden\" name=\"cptch_result\" value=\"euc=\" \/><input type=\"hidden\" name=\"cptch_time\" value=\"1776351858\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"cptch_form\" value=\"general\" \/>\n\t\t\t\t<\/label><span class=\"cptch_reload_button_wrap hide-if-no-js\">\n\t\t\t\t\t<noscript>\n\t\t\t\t\t\t<style type=\"text\/css\">\n\t\t\t\t\t\t\t.hide-if-no-js {\n\t\t\t\t\t\t\t\tdisplay: none !important;\n\t\t\t\t\t\t\t}\n\t\t\t\t\t\t<\/style>\n\t\t\t\t\t<\/noscript>\n\t\t\t\t\t<span class=\"cptch_reload_button dashicons dashicons-update\"><\/span>\n\t\t\t\t<\/span><\/span><\/p><\/i>\n                    <\/div>\n    <\/div>\n\n    <div class=\"row\">\n                                <div class=\"col-sm-5 \" scope=\"row\"><label>I accept the Conditions of Participation:<\/label><br  \/>\n\t\t\t\t<a href=\"https:\/\/mleczkodelikatesy.com\/wp-content\/plugins\/mleczko-register\/terms_and_conditions\/terms-uk.txt\" target=\"_blank\">\n\t\t\t\t<span style=\"color: red\">Terms and Conditions<\/span>\n\t\t\t<\/a>\n\t        <\/div>\n        <div class=\"col-sm-7 \">\n            <div class=\"pull-left\" style=\"padding-left: 17px; padding-bottom: 15px;\"><input type=\"checkbox\" name=\"mleczko[accepted]\" value=\"Y\"  \/><\/div>\n                    <\/div>\n    <\/div>\n<\/div>\n\n<p class=\"pull-right submit\"><input type=\"submit\" name=\"submit\" id=\"submit\" class=\"btn btn-danger\" value=\"Submit \u00bb\" \/><\/p>\n\n<\/form>\n<\/div>\n\n            <\/div>\n            <div class=\"col-xs-12 col-md-12\">\n                <img decoding=\"async\" class=\"img-responsive imgDownload hidden-xs hidden-sm\" src=\"https:\/\/mleczkodelikatesy.com\/wp-content\/themes\/Divi\/layout\/images\/karta-lojalnosciowa.jpg\" >\n            <\/div>\n<\/div>\n<\/div>\n[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.9.2&#8243; _module_preset=&#8221;default&#8221;][et_pb_image src=&#8221;https:\/\/mleczkodelikatesy.com\/wp-content\/uploads\/2020\/02\/opinie.jpg&#8221; title_text=&#8221;opinie&#8221; _builder_version=&#8221;4.9.2&#8243; _module_preset=&#8221;default&#8221;][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"container-fluid front-page-section\">\n<div class=\"row\">\n    <div class=\"col-xs-12 col-md-12\">\n\n<div class=\"loyalty-content\">\n\n<h4>Mleczko Loyalty Card Application Form<\/h4>\n\n<p>Fill out the form below. You will get a loyalty card and become a member of our loyalty program.<\/p>\n\n<p>The form can also be printed and filled deliver to one of our stores.<\/p>\n\n<p>* fields are required<\/p>\n\n<form name=\"mleczko-register-form\" method=\"post\" action=\"\">\n\n<div class=\"form-table\">\n\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>First name: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[first_name]\" id=\"mleczko_first_name\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Surname: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[last_name]\" id=\"mleczko_last_name\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Address  ( flat\/building number, street ): *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[address]\" id=\"mleczko_address\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Town: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[town]\" id=\"mleczko_town\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Country: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[country]\" id=\"mleczko_country\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Post code: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[post_code]\" id=\"mleczko_post_code\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Date of Birth: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[dob]\" id=\"mleczko_dob\" value=\"\" class=\"regular-text form-control\" placeholder=\"MM\/DD\/YYYY\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Telephone No.: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[telephone]\" id=\"mleczko_telephone\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>Mobile No.: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[mobile]\" id=\"mleczko_mobile\" value=\"\" class=\"regular-text form-control\" placeholder=\"+44 aaaa bbb ccc\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>E-mail Address: *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[email]\" id=\"mleczko_email\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>E-mail Address (verify): *<\/label><\/div>\n        <div class=\"col-sm-7 \">\n                        <input type=\"text\" name=\"mleczko[email_two]\" id=\"mleczko_email_two\" value=\"\" class=\"regular-text form-control\" placeholder=\"\" \/>\n        <\/div>\n    <\/div>\n\n    <div class=\"row\">\n                        <div class=\"col-sm-5 \" scope=\"row\"><label>reCaptcha verification:<\/label><\/div>\n        <div class=\"col-sm-7 \"><i><p class=\"cptch_block\"><span class=\"cptch_wrap cptch_math_actions\">\n\t\t\t\t<label class=\"cptch_label\" for=\"cptch_input_24\"><span class=\"cptch_span\"><input id=\"cptch_input_24\" class=\"cptch_input cptch_shortcode\" type=\"text\" autocomplete=\"off\" name=\"cptch_number\" value=\"\" maxlength=\"2\" size=\"2\" aria-required=\"true\" required=\"required\" style=\"margin-bottom:0;display:inline;font-size: 12px;width: 40px;\" \/><\/span>\n\t\t\t\t\t<span class=\"cptch_span\">&nbsp;&times;&nbsp;<\/span>\n\t\t\t\t\t<span class=\"cptch_span\">nin&#101;<\/span>\n\t\t\t\t\t<span class=\"cptch_span\">&nbsp;=&nbsp;<\/span>\n\t\t\t\t\t<span class=\"cptch_span\">45<\/span>\n\t\t\t\t\t<input type=\"hidden\" name=\"cptch_result\" value=\"KOo=\" \/><input type=\"hidden\" name=\"cptch_time\" value=\"1776351858\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"cptch_form\" value=\"general\" \/>\n\t\t\t\t<\/label><span class=\"cptch_reload_button_wrap hide-if-no-js\">\n\t\t\t\t\t<noscript>\n\t\t\t\t\t\t<style type=\"text\/css\">\n\t\t\t\t\t\t\t.hide-if-no-js {\n\t\t\t\t\t\t\t\tdisplay: none !important;\n\t\t\t\t\t\t\t}\n\t\t\t\t\t\t<\/style>\n\t\t\t\t\t<\/noscript>\n\t\t\t\t\t<span class=\"cptch_reload_button dashicons dashicons-update\"><\/span>\n\t\t\t\t<\/span><\/span><\/p><\/i>\n                    <\/div>\n    <\/div>\n\n    <div class=\"row\">\n                                <div class=\"col-sm-5 \" scope=\"row\"><label>I accept the Conditions of Participation:<\/label><br  \/>\n\t\t\t\t<a href=\"https:\/\/mleczkodelikatesy.com\/wp-content\/plugins\/mleczko-register\/terms_and_conditions\/terms-uk.txt\" target=\"_blank\">\n\t\t\t\t<span style=\"color: red\">Terms and Conditions<\/span>\n\t\t\t<\/a>\n\t        <\/div>\n        <div class=\"col-sm-7 \">\n            <div class=\"pull-left\" style=\"padding-left: 17px; padding-bottom: 15px;\"><input type=\"checkbox\" name=\"mleczko[accepted]\" value=\"Y\"  \/><\/div>\n                    <\/div>\n    <\/div>\n<\/div>\n\n<p class=\"pull-right submit\"><input type=\"submit\" name=\"submit\" id=\"submit\" class=\"btn btn-danger\" value=\"Submit \u00bb\" \/><\/p>\n\n<\/form>\n<\/div>\n\n            <\/div>\n            <div class=\"col-xs-12 col-md-12\">\n                <img decoding=\"async\" class=\"img-responsive imgDownload hidden-xs hidden-sm\" src=\"https:\/\/mleczkodelikatesy.com\/wp-content\/themes\/Divi\/layout\/images\/karta-lojalnosciowa.jpg\" >\n            <\/div>\n<\/div>\n<\/div>\n\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<!-- wp:columns -->\r\n<div class=\"wp-block-columns\"><\/div>\r\n<!-- \/wp:columns -->\r\n\r\n<!-- wp:paragraph -->\r\n<p><\/p>\r\n<!-- \/wp:paragraph 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