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SeniorDiscounts Card Business Registration



BUSINESS DETAILS
Business Name:  
More than one location:  
Select a Category:  
Add Category:
(if not listed above)
  
Select a SubCategory:  
Add SubCategory:
(if not listed above)
 
Address 1:  
Address 2:  
City:  
State:    
Zip/Postal Code:  -
If your business has multiple locations, please fill out this form for one of the locations and we will contact you to help you add the other locations.


BUSINESS CONTACT INFORMATION
Local Phone Number:   (ex: 123-4567) 
Fax Number:   (ex: 123-4567)
Toll Free Number:   (ex: 123-4567)
E-mail Address:    
Website Address:  
 


BUSINESS DESCRIPTION
Please briefly tell us and our SeniorDiscounts Card members about your business:
 
   


SENIOR DISCOUNT INFORMATION:
Senior Discount Offer:  
 
 
 
Senior Discount Restrictions:
(if any)
 
 
Age requirement   


PRIMARY CONTACT INFORMATION:
Contact's Name:  
Contact's Phone Number:   (ex: 123-4567)
Contact's E-mail Address:    
(This e-mail address will also be your username when logging in.)
Password:
Confirm Password:
E-mail Format:   
   


MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
Address is same as above:
Address 1:  
Address 2:  
City:  
State:  
Zip/Postal Code:  -


TERMS AND CONDITIONS:
Please read the Business Terms and Conditions before completing this registration.
Do you agree with the Terms and Conditions?    
   


SUBMIT YOUR INFORMATION
If you are satisfied that all of the information you have entered in the registration form is correct, please click the "Submit" button below.
 
After you submit your business application, we will contact you within one week.
 
 

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