Merchant Contract Form Merchant Contract Restaurant/Merchant Name * Required Phone * RequiredContact Person * Required First Last Email * Required Fax NumberAddress * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If you have multiple locations. Add those below.Website/Social Media 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 29 to November 7, 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. Restaurant/Merchant name (as you wish it to appear in the Directory):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 29 to November 7. - 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
