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* 1. Name of Company:

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* 2. Name of Company dba (if applicable):

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* 3. Kokua Kauai Card Point of Contact (POC):

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* 4. POC phone:

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* 5. POC email:

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* 6. Street address of business/Physical location:

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* 7. Mailing address of business:

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* 8. Company website:

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* 9. Company email for customers:

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* 10. Company phone number for customers:

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* 11. Kokua Kauai Card offer for qualified participants (please be as detailed as possible):

Your offer details should include (but are not limited to):

• What the offer is (special price point, discounted amount, percentage off, BOGO,  free appetizer with purchase of two entrees, etc.)

• Instructions on how to redeem the offer (restrictions and/or promo codes)

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* 12. Estimated value of offer per customer (dollar value required):

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* 13. The program requires that the participating business validate the qualified customer’s eligibility through presentation of a program identification card and that only customers with the identification card will be allowed to access the discount. Do you certify that you will comply with this validation process?

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* 14. The program requires that the participating business report to the Kauai Chamber of Commerce the number of customers who have accessed the discount and the estimated revenue generated by the program for the business on a monthly basis via a form provided by the Kauai Chamber of Commerce. Do you certify that you will comply with the reporting requirements?

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* 15. In order for the program to be successful, businesses must be immediately responsive to customers attempting to use the discount. Do you certify that all employees of your businesses who may be asked about the program by a participating customer will be aware of the program and the offer provided by your company?

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* 16. Please upload your company logo:

PNG, JPG, JPEG, GIF file types only.
Choose File

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* 17. Please leave any additional comments or questions here:

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