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* 1. Contact Name (First and Last):

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* 2. Business Name:

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* 3. Business Email:

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* 4. Business Category:

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* 5. Business Address/Phone Number:

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* 6. Business Website:

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* 7. Business Facebook url (if applicable)

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* 8. Business Instagram username (if applicable)

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* 9. What would you like your first promotion/discount to be (can add/edit promotions  later if needed)?

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* 10. What is the discount code for your promotion (online businesses only)?

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