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Mehmet
2024-08-15T11:34:36+00:00
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Your First Name
*
Your Last Name
*
Email
*
Name of your Business
*
Type of Business
*
Choose the type of business you have
Select your business type
Automotive
Bakeries
Bars
Beauty & SPAs
Coffee & Tea
Cosmetics & Skin Care
Dry Cleaning
Electronics
Gas Stations
Grocery
Hair Salons
Company website URL (optional)
Company logo (optional)
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Phone number of the Business
*
Employer number or social security number (optional)
Street address
*
City
*
State
*
Choose your state
Select your state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Owhi
Kansas
Entucky
Maine
Maryland
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hempshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Save the above address as billing address
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Acquirer Business Identification Number (BID), or Acquirer Merchant Identification Number (MID), or Tax ID.
Cashback Percentage
*
Please Select
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
11%
12%
13%
14h
15%
Offer End Date
*
Offer Terms
This Application is for:
myGini
Fairfield County Donation Program
By clicking here I hereby declare that we are a US based legitimate business entity currently accepting cards.
*
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We look forward to welcoming you to the myGini family and grow your bottom line.
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