Merchant - Information Request

If you would like to join the RewardTrak network as a merchant (advertiser), please fill in the following form by completing the fields below. All information is considered confidential and will only be used for internal evaluation and to expedite your request for information. We will carefully review the information and contact you as soon as possible.
First Name:
Last Name:
Job Title:
Email Address:
Confirm Email Address:
Company Name:
Website URL:
Postal Code:
Tax Classification:
Which are you? (Check all that apply)
Retail Merchant
Wholesale Drop Shipper
Product Manufacturer
Do you have an eCommerce capable website?
Do you use a shopping cart system?
If yes, which shopping cart system do you use?
How does your business fulfill orders? (Check all that apply)
Single order to consumer
Single order to wholesaler
Bulk order to wholesaler
How long has your company been selling products or services online?
What is your companies total online revenue for the past 12 months?
Please enter any questions you have about RewardTrak (400 characters maximum):

Character count:

I have read and accepted the RewardTrak Terms & Conditions Agreement . By clicking through this box you agree to be bound by the terms of the RewardTrak Terms and Conditions Agreement.
I have read and accepted the RewardTrak Privacy Policy . By checking this box you agree to be bound by the terms and conditions outlined in the Privacy Policy.
I am at least 18 years of age.