Retailer Sign Up Form

	Promo Code:
	Store Information
	Select Membership:	6 Month 12 Month (Plus Sponsor Coupons)
	Store Name:
	Store Address:
	Name of Contact:
	Email:
	Store Website :
	Phone #:
	Fax # :
	Approx. Sq. Footage:
	Store Hours:
	Year Established:
	Distance from Closest Interstate:
	Children's Area?	YesNo
	Crop Area?	YesNo
	Classes?	YesNo
	Please be as detailed as possible with the following questions.
	Primary Vendors:

	Our store's claims to fame / What makes your store special?

	Nearby Family/Children Activities:

	Nearby Restaurants:

	Other Important Information:

Once we receive your information we will contact you to get a credit card number. Your listing will not be posted until you have submitted a valid credit card.