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Business Name:

Business Type (Please list types of products & Services):


Physical Business Address:

City:                                 State:                                  Zip:

Mailing Business Address:

City:                                 State:                                   Zip:

Website:

Owner Name(s):

Manager Name(s):

Business Phone:                                     Owner/Manager Phone:

Business License #                                 State where issued:

Sales Tax Exempt Number (if any):

Do you accept credit cards? Y or N           If yes, please list types:


Do you have more than one location? Y or N

If yes, please list all locations you are willing to honor the "Jon's Adventure" Club Card:

(Use back of paper if needed.List addresses, phone numbers, and manager names)


If you only handle web businesses, please initial here:

(We will only list your mailing address, website and customer service phone #)

I/we agree to honor "Jon's Adventure" Club Cards at the above business location(s), and/or website(s).  I/we understand if I/we no longer want to participate in the discount card program, I/we must notify "Jon's Adventure" Club Card program by mail, at which point, the business will be removed from our list and services. I/we also understand we must offer some type of benefit to "Jon's Adventure"Club  card holders. The Discount is left to our discretion and may be a weekly, or monthly promo. Limitations and parameters are to be set by our business.

__________________________________      ________________________________

Owner Name (s)  Print Name                        Owner Name (s)    Print Name

__________________________________      ________________________________

Manager Name (s)   Print Name                    Manager Name (s)   Print Name

__________________________________       _______________________________

Authorized Signature (s) & Date                         Authorized Signature (s) & Date

This Contract is bound by the above agreements between "Jon's Adventure" Club Corp and the above business and people.

Check here, if you would like to retail Jon's Adventure Club Cards for 40% margin:____

PLEASE PRINT, FILL OUT COMPLETE FORM, SIGN AND MAIL TO:

Jon's Adventure Club

Merchant Application Dept.

POBox 901221

Sandy, Utah 84090-1221

DO NOT EMAIL THIS FORM ! THIS FORM MUST BE SIGNED AND RETURNED BY MAIL IN IT'S ENTIRETY.

(C) Copyright 2008 Jon's Adventure Show    801-647-5645

(R) Registered Trademark