Alumni

Benefit Partner Application

Please fill out the application. Once reviewed, our office will contact you with the next step in the process.

* indicates required fields.

Contact Information

* Company / Store Name:

* Contact Name:

* Title:

* Street Address:

* City:

* State/Province:

* ZIP/Postal Code:

* Phone Number:

* Email Address:

Discount Information

We would like to offer the following discount:

The discount will be posted on company or business website:

We would be interested in submitting a buck slip for future mailings:

We would like to be listed under the following category:

Other pertinent information about the discount (ie – only applicable if, at location A and B but not C, etc.):

Thank you for your time and we look forward to a productive and successful partnership opportunity.

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