Submit Form To Register & Offer PerkYA Incentives.
After submitting this form, we will review your application and then you will receive an email with the login access to your new "PerkYA Incentive Portal" within 48-72 hours once your first months subscription payment clears. *PerkYA reserves the right to disapprove or cancel certain applicants that do not qualify for any reason.
Who Referred You Or How Did You Hear About PerkYA ? (¿Quién te refirió o como supistes de PerkYA? )
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Your Name (Tu Nombre)
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First Name
Last Name
Email
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example@example.com
Phone Number
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Must Be Your Mobile Number.
What is your Occupation (¿Cuál es tu ocupación?)
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Are you a current client of ours? - ( ¿Eres actualmente cliente nuestro? )
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Yes
No
Your Company Name - ( Nombre de Tu Empresa )
What Is Your MID # ?
Qual es tu numero de MID ?
City Where You Are Located - (Ciudad donde vive)
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State Where You Are Located - (Estado donde vive)
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SELECT YOUR PLAN (Escoja Su Plan) | Visit PerkYA.com for full plan details (Visite PerkYA.com para detalles completos) - There is no contract, but there is a 3 month minimum. After the 3 months you may cancel your subscription anytime directly on the PerkYA website, with a 40 day minimum notice. No refunds or chargebacks will be given for previous subscriptions already paid to PerkYA. (FL 7% Sales Tax Will be added to the monthly subscription cost). (Other terms & conditions may apply).
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BASIC PLAN - $295 Per Month - (30 Monthly Restaurant Certificates Each worth between $25 & $200.)
SILVER PLAN - $495 Per Month - (50 Monthly Restaurant & Hotel Savings Cards Each worth between $25 & $200)
GOLD PLAN - $695 Per Month - ("UNLIMITED" Incentives of "ALL" Certificates Included in the BASIC & SILVER Plans ...PLUS : 4 Night Bahamas Cruise, Smart Devices, 7 Day Resort, $400 - $500 Restaurant & Hotel Savings & much more)
*SAVE $531 (15%) ON BASIC PLAN IF YOU PAY THE YEAR IN ADVANCE --- $3,009
*SAVE $891 (15%) ON SILVER PLAN IF YOU PAY THE YEAR IN ADVANCE --- $5,049
*SAVE $1,251 (15%) ON GOLD PLAN IF YOU PAY THE YEAR IN ADVANCE --- $7,089
*GET A 3 DAY FREE TRIAL OF THE "GOLD PLAN" ONCE YOU BECOME A PERKYA AMBASSADOR AND REFER A MINIMUM OF 5 OTHER LOCAL BUSINESS OWNERS THAT KNOW YOU PERSONALLY.
Did You Select The FREE 3 day Trial Above ?
Please Select
YES
NO
Type a question
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Any thoughts?
Service Quality
Cleanliness
Responsiveness
Friendliness
Upload your Drivers License So We May Verify Your Identity & Get You Approved.
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Search and Upload Files
Por favor, sube tu licencia de conducir para que podamos verificar tu identidad y aprobar tu solicitud.
Cancel
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Below, you will need to select which Bank Identification you prefer to give us. We require this to charge your monthly subscriptions to the correct bank account. --- (A continuación, necesitarás seleccionar qué Identificación Bancaria prefieres proporcionarnos... Requerimos esto para poder cobrar tus pagos mensuales a la cuenta bancaria correcta.)
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Please Select
I will enter my 'BANK and ROUTING number.
I will upload my "VOIDED CHECK".
Enter Your Bank Name
Ingrese el nombre de su banco.
Enter Your Bank Account #
Ingrese el número de su cuenta bancaria.
Enter Your Bank Routing # (9 digits)
Ingrese el número de ruta bancaria de su banco. (Son 9 digitos)
Upload your "Company Voided Check" where we will deduct your subscription payments every month.
Search and Upload Files
Sube un "Cheque Anulado de la compania" donde recibiras tus pagos de comisión cada mes.
Cancel
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SIGNATURE - (FIRMAR) | By signing below, you agree to all terms and conditions stated herein.
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sales_rep
mbsy
Enter the security message as it's shown.
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SUBMIT THIS FORM TO GET STARTED
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