Business Registration Form

Register Your Business

Please provide all required details to register your business with us
Business Owner*

First NameLast Name
Business Name*
Contact Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business*
Others*
Message

Registration Fee - includes 1 store window decal. Please allow 2-4 weeks for delivery due to COVID-19 impact on shipping. *

Basic Business Member Registration

List your business and help support teen mental health! Your store window decal shows your clients & customers that your establishment supports DDAAT-APP!, your local community, & teen mental health.

$99.00 Quantity

Advertise here (for 1 year from date of purchase) when you add your organization’s logo to our supporting businesses page by uploading your jpg logo file below and submitting your $1000 advertisement fee below. (Note: graphic or inappropriate uploads will not be posted and funds will not be refunded).

Limited time offer- Get 50% the regular advertising fee ($1000.00/year)off advertising your business logo on our website. Sign up now for $500/year!

$500.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

File Upload

Cancelof
Should be Empty:

Register Your Business