Let's Get Started

Tell us about your business and how we can work together by filling out all required fields in the form below.

In order to process your application, a $35 fee will be applied upon approval.

About You

First name {{errors.first('prospect[rep_first_name]')}}

Last name {{errors.first('prospect[rep_last_name]')}}

Email address {{errors.first('prospect[rep_email_address]')}}

About Your Business

Company name {{errors.first('prospect[merchant_name]')}}

Legal Company Name {{errors.first('prospect[merchant_legal_name]')}}

Company Address {{errors.first('prospect[merchant_address]')}}

Company Website {{errors.first('prospect[merchant_url]')}}

E-commerce Website (if different from company) {{errors.first('merchant_ecommerce_url]')}}

Website Shopping Cart Provider Name (if applies)

Primary Contact Name {{errors.first('prospect[merchant_primary_contact_name]')}}

Primary Contact Email {{errors.first('prospect[merchant_primary_contact_email]')}}

Billing Contact Name {{errors.first('prospect[merchant_billing_contact_name]')}}

Billing Email Address {{errors.first('prospect[merchant_billing_contact_email]')}}

Billing Phone Number {{errors.first('prospect[merchant_billing_phone_number]')}}

Customer Service Contact Name {{errors.first('prospect[merchant_customer_service_name]')}}

Customer Service Email Address {{errors.first('prospect[merchant_customer_service_email]')}}

Did you hear about us through Loving the Locals? {{errors.first('prospect[loving_the_locals]')}}

Yes

Do you have an Amazon store? {{errors.first('prospect[amazon_merchant]')}}

Yes

Amazon Seller Name {{errors.first('prospect[amazon_seller_name]')}}

Amazon Store Link {{errors.first('prospect[merchant_amazon_url]')}}

List any additional Amazon store links you will be submitting deals for here:

List the store names that will need to be billed separately here:

List the brands you have authorization to promote on Amazon:

Do you belong to an affiliate network? {{errors.first('prospect[affiliate_network]')}}

Select from the list below if you do not have an Affiliate Network Program: {{errors.first('prospect[alternate_tracking_network]')}}

What is your network ID #: {{errors.first('prospect[affiliate_network_id]')}}

Primary category that you offer {{errors.first('prospect[category]')}}

Range of individual items usually in inventory? {{errors.first('prospect[inventory_available]')}}

0 - 100

101 - 500

Over 500

Do you offer free shipping? {{errors.first('prospect[shipping]')}}

Yes, always

Yes, with minimum purchase

Other

Other (Optional)

US based? {{errors.first('prospect[us_based]')}}

Yes

Are you an Agency? {{errors.first('prospect[agency]')}}

Yes

Do you have a sale or clearance section of your site? {{errors.first('prospect[sale_section]')}}

Yes

URL (Optional) {{errors.first('prospect[sale_url]')}}

Can you offer exclusives to Brad's Deals? {{errors.first('prospect[bd_exclusives]')}}

Yes

Has this company worked with Brad's Deals in the past? {{errors.first('prospect[bd_history]')}}

Yes

Primary merchant goal? {{errors.first('prospect[goal]')}}

Sales Volume

New Users

Reactivate Old Users

Other

Product Info (Optional)

Additional Info (Optional)

I understand a $35 fee will be charged upon approval of application. {{errors.first('prospect[app_fee]')}}