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 merchant Maximum number of Vouchers Available* 500 + 100 to 499 51 to 99 25 to 50 <25 What is your current or most important business need(s)/goal(s)? (Please pick your top one or more choices(s) Increase Margin Clear Inventory Profitably drive traffic Increase average transaction value Drive awareness Other Yelp 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 deal Yes card-linked offer Yes, both No, neither Is this a refferal? Yes No Business NameBusiness IDContact Full NameContact Email Contact PhoneContact Other ID
