Retailer Registration

Sign up now for 2023!

Retailer Registration

Business Information

Please enter the Business Information exactly as you'd like it listed in the directory. Rest assured that we will never give or sell your information to any third party.

Business Name(Required)

How did you hear about us?

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Business Phone(Required)

Facebook Handle / User Name

Instagram Handle / User Name

Website

Please enter your Website full URL, including https:// or http://

Offer Discount to Online Shoppers?

Yes

Online Shopping Merchant Code (Optional)

Please provide a discount code that can be used by online shoppers during the time of the promotion. You will need to enable this code on your website during the promotional period.

Local Contact Information

Local Contact Name(Required)

First Last

Local Contact Title(Required)

Local Contact Email(Required)

Local Contact Phone(Required)

Corporate Information

Corporate Contact Name(Required)

Corporate Contact Title(Required)

Corporate Contact Email(Required)

Corporate Contact Phone(Required)

Corporate Address(Required)

Street Address Address Line 2 City State ZIP Code

Social Media Manager Information

Social Media Contact Name

First Last

Social Media Contact Email

Social Media Contact Phone

Listing Information

Location (Area of Town)(Required)

Business Category(Required)

Description & Exclusions(Required)

Please provide a brief description exactly as you want it to appear in promotional materials. Descriptions over 15 words may be edited at the discretion of the Happy Lungs Project. Please list all exclusions, if any. (Maximum 300 characters)

OFFERING (IF RESTAURANT)

10% off meal with minimum purchase, excludes alcohol

Complimentary appetizer/dessert with purchase of an entrée

Stand Out

We offer the option to enhance your visibility by highlighting your listing. For a minimum donation of $250, your name, location and description will be highlighted and listed as Bronze Sponsor.

Would you like your listing to be highlighted? (with $250 minimum donation.)(Required)

YES

NO THANKS

Participant Agreement

For retail stores: We agree to offer a 20% discount on all regular retail prices from October 27 - November 5, 2023 to all holders of a Happy Lungs Shopping Card. All exclusions must be noted on this agreement. We agree not to limit the number of transactions per card holder during this period.

For restaurants: We agree to offer discounts as selected above from October 27 - November 5, 2023 to all holders of a Happy Lungs Shopping Card. We agree not to limit the number of transactions per card holder during this period.

We agree to advise all our personnel of this arrangement and to promote card purchases using the QR code or URL on the promotional materials in the store/restaurant.

We agree to place promotional materials prominently in our store/restaurant.

We agree that the Happy Lungs Shopping Card is non-transferable and may be used only by the person whose name appears on the card. We agree to check ID and to allow only the card holder to make purchases.

We understand that the Happy Lungs Project assumes no liability in connection with the Happy Lungs Shopping Card, merchandise sold by our store(s)/restaurant(s) or otherwise.

We understand that by participating in this program, we are opting in to receive email updates and that we may opt out at any time.

I agree to the terms of this Participant Agreement and confirm our participation in the Happy Lungs Shopping Card fundraising program to benefit the Happy Lungs Project.

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Participant Agreement

For retail stores: We agree to offer a 20% discount on all regular retail prices from October 28 - November 6, 2022 to all holders of a Happy Lungs Shopping Card. All exclusions must be noted on this agreement. We agree not to limit the number of transactions per card holder during this period. 
For restaurants: We agree to offer discounts as selected above from October 28 - November 6, 2022 to all holders of a Happy Lungs Shopping Card. We agree not to limit the number of transactions per card holder during this period. 
We agree to advise all our personnel of this arrangement and to promote card purchases using the QR code or URL on the promotional materials in the store/restaurant. 
We agree to place promotional materials prominently in our store/restaurant. 
We agree that the Happy Lungs Shopping Card is non-transferable and may be used only by the person whose name appears on the card. We agree to check ID and to allow only the card holder to make purchases. 
We understand that the Happy Lungs Project assumes no liability in connection with the Happy Lungs Shopping Card, merchandise sold by our store(s)/restaurant(s) or otherwise. 
I agree to the terms of this Participant Agreement and confirm our participation in the Happy Lungs Shopping Card fundraising program to benefit the Happy Lungs Project.

Participant Confirmation(Required)

I agree to the terms

Authorized Representative Digital Signature(Required)

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