Online Member Perks Participation Form

Use this online form to sign up your business for the Member Perks program.

 

Date:

Contact Name: Title:

Merchant:

Address:

City: State: Zip:

Contact Phone: Business Phone: Fax:

Website Address (for linking purposes):

Contact Email:

Dining Establishments:

My Offer: One complimentary lunch or dinner entree when a second lunch or dinner entree of equal or greater value is purchased up to $ value.
My Offer: Enjoy one when a second of equal or greater value is purchased up to $ value.
My Offer: Enjoy one complimentary menu item when a second menu item of equal or greater value is purchased up to $ value.
My Offer: Receive a 50% discount off to $ value.

Entertainment & Service Establishments:

My Offer: Enjoy one complimentary admission when a second admission of equal or greater value is purchased up to $ value.
My Offer: Enjoy one when a second of equal or greater value is purchased up to $ value.
My Offer: Retail discount of 15% 20% 25% off .

Dates of offer - Offer Begins On: Offer Expires On: .

Comments, Questions or Suggestions:

By hitting the submit button below, you are stating that you have the authority to make discounts/coupons for this Merchant, and you are stating that you have reviewed this offer and hereby agree to allow CMOM to include the offer on its website (cmom.com) for the specified dates of offer.