Business Sign-up Form: Community Gift Card

Business Sign-up Form: Community Gift Card

Please complete this form so that your business can become eligible to take our community gift card! This form is powered by Jotform, which uses the highest levels of encryption. This form will be sent directly to Factor4 our gift card service provider.
Legal Name of Business*
DBA Name or Trade Name*
Company Name
Number of Locations
Company Address*
City*
State*
Zip*
Company Phone*
Fax

Area CodePhone Number
Website*
Contact Information
Primary Contact*
Phone*
Email*
example@example.com
Secondary Contact
Phone
Email
example@example.com
Electronic Funds Transfer Agreement

We understand agreements can be tricky! The below outlines the basics of the Factor 4 (Our Gift Card Service Provider). Please know, your agreement is a sub agreement of The Oak Park and River Forest Chamber's Agreement. We have to present this information to you, but the chamber is covering all fees associated with this program. If you have any questions, please reach out to Darien Marion-Burton, Executive Director at dmarionburton@oprfchamber.org
Pursuant to the Merchant Agreement for Transaction Services it is necessary for Merchant to provide Factor4 with its banking information to facilitate billing and payments. It is the Merchant’s obligation to inform Factor4 of any changes to its banking details and accounts. Factor4 will not be liable for any funds incorrectly transferred as a result of a change in banking information or errors that directly resulted from information provided by Merchant.

Merchant authorizes Factor4 to debit from the Merchant’s bank account all monthly payments and other amounts owed to Factor4 related to the Transaction Services. This authorization shall remain in effect after termination of the Agreement and for as long as Merchant owes any amounts to Factor4. Merchant agrees that Factor4 will not be liable for any loss or damage incurred as a result of anything done or not done pursuant to this authorization. If the account is transferred to another branch or the account is closed and an account is opened at another bank this authorization shall have the same force and affect as if it originally was directed to that branch or bank.
Electronic Funds Transfer Information
Bank Name*
Branch*
City*
State*
9-Digit Bank Routing Number*
Account Number*
The legal business acknowledges and agrees to all the terms and conditions of this Agreement and unconditionally guarantee the performance of this Agreement. By signing below, Merchant (I) represents that the information provided by Merchant in this Agreement is true, complete and not misleading; (II) acknowledges that Merchant has read and understands this Agreement and Operating Procedures and agrees to be bound by their terms; and (III) authorizes Gift Loyalty Services and its agents to credit and debit the Designated Automatic Funds Transfer Account in accordance with this Agreement.
Principal (Signature Required)

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Title
Print Name
Date

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For full Factor4 Merchant Agreement visit: www.factor4gift.com/merchant-agreement.
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Business Sign-up Form: Community Gift Card

Contact Information

Electronic Funds Transfer Agreement

Electronic Funds Transfer Information