AllergyBites Discount Card Application Form

AllergyBites Discount Card Application Form

Please provide all requested details below.
Your business
Business Name *
Business Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Business Website *
Facebook URL
(if applicable)
Twitter URL
(if applicable)
Instagram URL
(if applicable)
Your discount

Describe the discount (or other promotion) you are offering cardholders. Note that a discount should be available to cardholders year-round. (Exceptions are made for special circumstances. Please explain under "Restrictions.")
Discount *
Restriction(s)
(if applicable)
Promo Code
(for online businesses only)
About your business

Please describe your business in 50-100 words. Note: The listing you provide is what will appear on the AllergyBites promotional page.
Your listing *
Your logo

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Contact information

This information will not be shared publicly.
Contact Name *
Contact Phone Number *

Area Code Phone Number
Contact Email *
example@example.com
Should be Empty: