Merchant Release Form

Green Living Savings Guide

The Ultimate Green card

Merchant Agreement and Release Form

The following information pertains to the discount rate you have chosen. Please mark all of the appropriate boxes or enter the information in the field marked other if you do not see yours listed.

This information is for our records only and will never be sold to any third parties.

Free gift with minimum purchase of
Free shipping
Free shipping for orders over
Annual Discount of
Monthly discount of
Discount with every visit
Buy one get one free
Buy one get one half off
Other
If you will be using an online coupon code please enter it here

If you would like to provide a description of your business please add it here (optional)

Contact Information

Business Name

Business Address

Phone

Fax

Website

E-Mail

E-Signature of decision maker(s)