New Merchant / Advertiser Sign-up Form

1
Business / Brand Name:* This field is required.Input your BRAND name
2
Type of Business* This field is required.Select any one your business category
Please Select
Please Select
Restaurants
Hotels & Resorts
Cafes
Services
Auto
Entertainment
Travel & Tour
Fitness
Health
Men's Deal
Women's Deal
Kids Deal
3
Web siteInput your business website link. (Optional)
4
FacebookInput your Facebook business page link
www.facebook.com/yourbusinesspageid
5
Instagram Input your Instagram page link. (Optional)
www.instagram.com/yourbusinesspageid
6
E-mailInput your business email address. (Optional)
business@businessdomain.com
7
Landline #Kindly input your business landline no.
8
Cell / WhatsApp #* This field is required.Kindly input your mobile phone no.
9
Business Address* This field is required.Input your business address details with near famous landmark
Street Address
Street Address Line 2
City
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Country* This field is required.
11
Click to Business Logo* This field is required.Upload your brand logo high quality images.
Drag and drop files here
Select files to upload
Max. file size: 1.0MB
Download your business logo
Cancelof
12
Full Name* This field is required.
Mr.
Mr.
Mrs.
Miss
Prefix
First Name
Last Name
13
Designation* This field is required.Select your status in this business
Please Select
Please Select
Owner
Partner
Manager
14
Contact Detail* This field is required.Input your personal contact number
15
Current Date:* This field is required.
Date
Day
Month
Year
4
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
00
10
20
30
40
50
Minutes
PM
AM
PM
16
EXCLUSIVE OFFERS / DEALS DETAILS* This field is required.Input your Offers / Deals details to avail our Mobile app (amClubDeal) Users
17
Rule Of Use* This field is required.Terms & Conditions Apply
18
Offers / Coupons Redemption Limits* This field is required.How many Coupons USER can redeem at the time on each outlet?
1 Coupon
2 Coupons
3 Coupons
4 Coupons
5 Coupons
19
Redemption Report * This field is required.Do you require customer Transections / Redemption Report on your Email account?
YESNO
20
Email Address * This field is required.Kindly input your email address
example@example.com
Confirm Email
21
Referrer
22
User Agent String
23
PROMOTIONAL AGREEMENT* This field is required.Between BAYANAT AL MADINA INFORMATION TECHNOLOGY SERVICES & Merchant (Advertiser)
24
Business Branches?* This field is required.How many branches do you want add in our app?
input numbers of branches/outlet.
25
Outlets Details Add branches with complete address, near landmark & contact details.
26
SUBSCRIPTION PLAN* This field is required.Yearly subscription for each branch / outlet. (less then 0.50$ cent per day)
prevnext( X )
Each Branch / Outlet
Included • Add your branch details with pin location on app. • User can redeem coupons through unique pin code or QR code. • Maximum 5 coupons add for each user. • User can be redeem multiple coupons at the same time as per agreement. • Transections Report by Email. • Offers/Deals can be change multiple times during contract period. • Users can redeem Deals by visit at the place only. • Your business social media & web link, photos, logo will be add on app.
$150.00 for each year
SUBSCRIBE
Total cost $0.00
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