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.

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

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

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

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

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

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]')}}

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 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]')}}

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

Yes

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

Yes

Primary merchant goal?

Sales Volume

New Users

Reactivate Old Users

Other

Other primary merchant goal? {{errors.first('prospect[other_primary]')}}

Additional Info (Optional)

How did you hear about Brad's Deals and opportunities to work with us? {{errors.first('prospect[referral]')}}

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