Merchant Sign Up Form
Thank you for your interest in joining the Shop Middle Michigan Gift Card Program! After your submission, our team will review your information to make sure you meet the criteria of the program. Once you are approved, we will send you an email with your activation card.
Business/Organization Name:
*
Business/Organization Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business/Organization Phone:
*
Please enter a valid phone number.
Website Address (if applicable):
Contact Name:
*
First Name
Last Name
Contact Email:
*
example@example.com
Contact Phone (if different than above):
Please enter a valid phone number.
Submit
Should be Empty: