Fun n' Food Card Sign Up Form

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Program Benefit Options   Sell Fun n' Food Card on consignment and receive 50% commission Yes!         Activate Fun n' Food Card and receive .5% on every card transaction Yes!         System will allow you to set up your own in-house gift card / loyalty program Yes!         Receive discounted rate on your current credit card processing Yes! Discounts OFFER 2 FOR 1 AND GET A TRIPLE BONUS! 2% CASH BACK Drawn & Labeled on Map ($250 value) Preferred Listing Visitor Discount % %  /   % Yes!   Gross Commission Net Commission (published rate)           Oahu Marriott Vacation Club: 15% - Mandatory Discount Yes!         Free Food or Gift Item:   Yes!             POINTS ONLY : Yes! Company Information   Company Name   Company Tax ID Number of Locations Company Address Company City Company State Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. Wisconsin West Virginia Wyoming Company Zip Company Phone Company Fax Contact Name Contact Phone Contact Fax E-Mail     Pre-Authorization Information   Bank Name Bank Address Bank City Bank State Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. Wisconsin West Virginia Wyoming Bank Zip Bank Branch Bank Account # Bank Routing # MC/Visa Merchant Acct # Terminal/Printer Make/Model Effective Date for Program  MM/DD/YYYY