*1.Please enter the following information(Required.)

Company Name: *

Website:

Contact Name & Title with Company

Address:

City/Town:

State:

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP:

Email:

Phone Number: *

Fax Number:

*2.What products or services does your company offer?(Required.)

*3.What is the AAA discount you are proposing to offer to our members? (As part of our quality standards, we ask that the member discount be more or of equal value to the best discount you currently provide. This includes current military and/or senior citizen discount.)

(Required.)

*4.How will members obtain the discount?

(Required.)

Please Select

In-Store

Please Select

Online

Please Select

Phone

Please Select

*5.How many years has your company been in business? (As part of our quality standards, we ask that all companies must have been in business for a minimum of 3 years before participating in AAA’s discount program).

(Required.)

*6.Is your company part of the Better Business Bureau? If so, what is your company rating with the BBB?

(Required.)

*7.How does your company plan to promote the AAA partnership? (Newspaper, radio, website, email, yellow pages)

(Required.)

8.What other value added features can your company offer to AAA members? (Special AAA member days, additional seasonal discounts, promotional items for AAA events)

*9.Who are your company’s main competitors?

(Required.)

*10.Are you able to provide a tracking/usage report?

(Required.)