ShopTalkTV.COM℠ Registration

Business Name

Tax Identification Number (TIN)

Merchant ID Number (MID)

Business Owner's Name

FirstLast

Business Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact Telephone Number

Area CodePhone Number

Mobile Number

Area CodePhone Number

Email

Were you referred to join Shop Local?

How did you learn about ShopTalkTV.COMl?

Account Associate

Invite your mobile customers to become members of your Free Deal Alerts VIP Club to receive exclusive offers. Your Free Deal Alerts trial will begin with your 1st text promotion so although there's no rush, the sooner you're set up the sooner you're ready to start sharing deals.

Confirmation Call Back (M-F)

Other

I would like to receive a Free ShopTalkTV.COM Video Demo. I understand this Demo Video is created for personal review only and will not be used for commercial or other marketing purposes.

Authorized E-signature

Your Unique Deal Alerts Short Code will begin with SHOP followed by the last 4 digits of your main telephone number (ex SHOP4567). This is the short code your customers will text from their mobile phone to join your VIP Club (or any name you choose for your campaign.) Enter the last 4 digits of your main telephone number now... Setting up your FREE Deal Alerts account is easy as 1, 2, 3: Enter your 4 digit short code (see below) *Submit this form including your 4 digit short codeYou will receive a text message when your Deal Alerts are live (normally within 24-48 business hours after receiving information* Receiving short code numbers are based on availability** It is agreed that participation in the Market America-SHOP.COM "Shop Local" & ShopYourBlock.com "Deal Alerts" promotions authorizes text messages to be sent to all participants for marketing purposes. Message & data rates may apply

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