ShopTalkTV.COM℠ Registration

SHOPTALKTV.COM

FREE VIDEO DEMO AUTHORIZATION
Business Name *
Tax Identification Number (TIN) *
Merchant ID Number (MID) *
Business Owner's Name *

First Last
Business Location *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Telephone Number *

Area Code Phone Number
Mobile Number

Area Code Phone Number
Email *
Were you referred to join Shop Local? *

YES No
How did you learn about ShopTalkTV.COMl?

Shop Local Owner/Associate Mail Direct Email TV Telephone Social Media (Facebook, Twitter, etc.) Radio Newspaper Magazine Public Event
Account Associate *

Jerry Hall #006107031 info@ShopYourBlock.com
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) *

Before 12p.m. EST After 12p.m. EST
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.

YES Not at this time
Authorized E-signature *

Clear
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
Comments
Enter the message as it's shown *
Should be Empty:

SHOPTALKTV.COM