GiftAMeal Sign Up Form - MRA Discount

How many locations are you signing up? (Maximum 5 for Online Sign-Up) *

Start Date * +

Restaurant Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (2) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (3) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (4) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (5) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Plans:

Subscription Type *

Month-to-Month (10% discount)

Annual (25% discount)

Plan: *

Lite - $44/month

Standard - $71/month

Premium - $134/month

Plan: *

Lite - $441/year

Standard - $711/year

Premium - $1341/year

Subscription Type *

Month-to-Month (10% discount)

Annual (25% discount)

Plan: *

Lite - $44/month per location

Standard - $71/month per location

Premium - $134/month per location

Plan: *

Lite - $441/year per location

Standard - $711/year per location

Premium - $1341/year per location

First Name *

Last Name *

Title *

Individual's Phone Number *

Email Address *

Payment Options *

ACH Collection

Credit Card

Credit Card

Cardholder Name (as it appears on the credit card) *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code *

Billing Address:

Street Address *

Address Line 2

City *

State *

Zip Code *

Authorize Credit Card Payments *

Restaurant elects to make payments via pre-authorized credit card charges.

ACH Collection

Business Name (as it appears on the account) *

Account Type *

Checking

Saving

Personal or Business *

Personal

Business

Bank Name *

Bank Transit Routing Number - ACH (9 digits) *

Bank Account Number *

Authorize ACH Collection *

Restaurant elects to make payments via pre-authorized automatic clearinghouse (“ACH”) debits.

GiftAMeal’s Terms and Services Agreement

Terms *

Restaurant agrees to GiftAMeal’s Terms and Services Agreement, which are attached hereto and incorporated herein by this reference.

Signature *

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