Loyalty Program Form First Name*Last Name*Title*Email*Company Name*Phone*Street*City*Zip*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBusiness InformationType of Business*Local: My business operates one or more retails/stores establishments (restaurant, spa, home, services etc.)Online: My business is primary an online merchant or distributor selling goods or services to a customer base across U.S.Operational Region/Market*AtlantaAustinBaltimoreBostonBrooklyn New YorkBuffalo New YorkCharlotteChicagoColumbusDallasDenverDetroitFort WorthHoustonIndianapolisJacksonvilleKansas CityLas VegasLos AngelesMemphisMiamiMilwaukeeMinneapolisNashvilleNew YorkOakland/ East BayOklahoma CityOmahaOrange CountyOrlandoPhiladelphiaPhoenixPittsburghPortlandRochester, NYSacramentoSaint LouisSaint PaulSalt Lake CitySan AntonioSan DiegoSan FranciscoSan JoseSeattleTampaWashington D.C.(Please pick the region(s)/market(s) that your business operates in using the dropdown menu)Category*ActivitesEvents and EntertainmentFitnessFoodHealth & MedicalHome ServicesNightlifeRestaurantsShoppingSpa and SalonsTravel and Transportations(Please pick the category that best describes your business using the dropdown menu)Subcategorybike rentalsbowlingclasses-lessons-othercooking lessonsdance classesextreme-sports- otherfamily activitiesflyinggolfgroup activities-otherhorse back ridingindor sports gamekaraokelimomotor sportsmusic lessonspaintballskydivingteam sports (Please pick the category that best describes your business using the dropdown menu)Subcategorycomedyevents-otherfestivalsmuseumsmusic lessonsprivate partiessporting eventstheater cinematours-landmarks(Please pick the category that best describes your business using the dropdown menu)Subcategorybootcampsboxingfitness classes-othergym membershipsmartial artspersonal trainerspilatespole dancingyoga (Please pick the category that best describes your business using the dropdown menu)Subcategoryalcohol-tobaccobakeriescoffee-teadelivery-cateringdesserts-sweetsfood-othergrocery-producejuice-ice cream (Please pick the category that best describes your business using the dropdown menu)Subcategorybeauty procedureschiropractorsdentistshair removalholisticmedical-othernutritionists-weight lossteeth whitening (Please pick the category that best describes your business using the dropdown menu)Subcategoryapparel-accesory-repairautomotivecar washcarpet cleaningelectronics-appliance-repair (Please pick the category that best describes your business using the dropdown menu)Subcategorybarsnight clubswine bars(Please pick the category that best describes your business using the dropdown menu)SubcategoryAfricanAmerican-OtherAsianBrazilianBreakfast-BrunchBurgersChineseDelis-DinersEuropeanIndianItalianJapaneseLatinMediterraneanMexicanMiddle EasternPizzaSeafoodSushiThaiVegetarian-Vegan(Please pick the category that best describes your business using the dropdown menu)Subcategorybeautyclothingbooks-mediaclothing-children'sclothing-men'sclothing-women'sclothing-accessoriesdrug storeselectronics-officeflowersfurnituregardeninghome goodsjewelryother retailprint-stationaryshoe storessporting goodstoy storesused-vintage(Please pick the category that best describes your business using the dropdown menu)Subcategorybarberseyelasheseyebrows-facialshair treatmentsmake upmassagenailssalon-otherspa-othertanningwaxingwomen's haircut(Please pick the category that best describes your business using the dropdown menu)Subcategorycar rentalscar service-cabdestinationshotelstransportation-other (Please pick the category that best describes your business using the dropdown menu)Avg. number of Locations per Region/Market*3 +1-2 or online merchantMaximum number of Vouchers Available*500 +100 to 49951 to 9925 to 50<25What is your current or most important business need(s)/goal(s)? (Please pick your top one or more choices(s)Increase MarginClear InventoryProfitably drive trafficIncrease average transaction valueDrive awarenessOtherYelp Star Rating (Please Skip if your business does not have a Yelp Rating at this time.)4 (w/5+ Yelp reviews)3.5 (w/5+ Yelp reviews)3 (w/5+ Yelp reviews)2.5 (w/100+ Yelp reviews)Number of Yelp reviewsHas your business ever run a deal/offer on other deal sites past?Yes, pre-paid dealYes card-linked offerYes, bothNo, neitherIs this a refferal?YesNoBusiness NameBusiness IDContact Full NameContact EmailContact PhoneContact Other ID Δ
