Merchant Contract Form Merchant Contract Restaurant/Merchant Name (as you wish it to appear in the Directory): * Required Phone * RequiredContact Person * Required First Last Email * Required Fax NumberAddress * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If you have multiple locations. Add those below.Website Facebook Instagram This contract confirms our participation in the Partners Card fundraising program to benefit Winthrop P. Rockefeller Cancer Institute Auxiliary, an Arkansas non-profit organization. We agree to offer a 20% discount excluding alcohol. The following conditions apply: – The Partners Card entitles shoppers to a 20% discount during the 10-day shopping period from October 27 to November 5, ONLY. The Partners Card is non-transferable. – We agree to advise all restaurant/merchant personnel of this agreement, and to promote the purchase of the Partners Card. – We acknowledge that the Cancer Institute Auxiliary retains all proceeds from the sale of the Card. – The Cancer Institute Auxiliary assumes no liability in connection with Partners Card or otherwise. – We are not required to honor the Partners Card 20% discount on already reduced “sale” merchandise. – All store merchandise is to be discounted 20% for Partners Card holders unless otherwise noted on the contract. – Compliance with these conditions is required for continued participation in Partners Card. EXCLUSIONS, IF ANY, MUST BE NOTED ON THIS CONTRACT/Application. Fifteen word description of the restaurant/business, noting exclusions, if any: It will be printed in the cardholders’ information that alcohol and tip are excluded from the discount. UAMS Partners Card has the right to change or correct a description for printing purposes. Please indicate below if the description will remain the same as last year.Description * RequiredWe would like to sell the Partners Card at our location: * Required Yes No – Management and sales personnel agree to promote the purchase of the card. – We understand that the Partners Card is to be issued only to individuals (not families or companies). – We agree to make the Card available for purchase in our store(s) from October 27 to November 5. – We agree to control validated cards and the funds received from card sales until collection. If you have questions, call Susan Jones (501) 686-8286 or email jonessusank@uams.edu or shhenry@uams.edu Partners Card Agreement accepted by: First Last
