Source Referral Landing Page
Please complete this form with as much information as possible to complete the landing page.
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Sample *
Business Address
This will be the location used for Geo-targeting. Only your primary location will be listed on the website. If do not have a physical location, please enter city and zip code.
Business Phone
Please use this format: Primary: 123-456-7890, Cell: 987-654-3210
Business Email Address
This is the email address that will be shown on the Landing Page.
Business Website Address
Main contact person who will manage the account
Include name & title  (John Smith, Owner)
Email address of the primary contact who will manage your account
Phone number(s) of the primary contact who will manage your account
Business email address for receiving referrals/offer confirmations
This is the email address for receiving offer/reward notifications and confirmations.
Check all social media accounts to be featured on landing page.
Please provide your urls for each social media account you wish to feature.
If these are not readily available, we will do our best to locate your accounts.
List the products/services to be listed on Landing page.
Separate each product/service with a comma. Example: Service 1, Service 2, Service 3, Service 4, etc.
Please pull information from website to create "About Us"
Clear selection
OFFER #1
Offer #1: $XX OFF your purchase of $XXX or more. Limitations apply. See store for details. Upon presentation of QR Offer Code.
REWARD #1
Receive a $XXX Gift Card when OFFER #1 is redeemed from your referral by a new client.
OFFER #2
Offer #2: $XX OFF your purchase of $XXX or more. Limitations apply. See store for details. Upon presentation of QR Offer Code.
REWARD #2
Receive a $XXX Gift Card when OFFER #2 is redeemed from your referral by a new client.
Use information from website to create blog information.
Clear selection
Check any online content published on behalf of the business.
Online Articles
If the business can provide links to online articles, please enter the links below.
How will images be delivered?
Online Videos
If the business can provide links to online videos, please enter the links below.
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