Mother Tree Birth

	please take a moment to fill out this form completely.
business name
business ADDRESS
CITY
STATE/ZIP
Phone
FAX
FIRST name
last name
E-mail
WEBSITE
REferred by
COUPON (FRONT CONTENT): SAMPLE BELOW: Please submit each coupon's information separately if you are doing more than one. Thank you.
COUPON quantity
Logo	Upload logos or photos as attachments to this mail link. Thank you.
Title or offer	50 char. max.
Add'l. text (front)	100 char. max.
Promo. code	If Applicable
FINE PRINT (Front)	100 char. max.
COUPON (BACK CONTENT): SAMPLE
INCLUDE BUSINESS INFO	Name and address Phone FAX Email Website Hours	Please check each box that you would like to see appear on the back of the coupon, below its expiration date. Thanks.
Back text	250 char. max.
REdeemable at	50 char. max.
MEMBER AGREEMENT: Member agrees to provide an offer that is valid from Feb. 14, 2008 to Feb.14 2009 and honor offer as specified in printed coupon. Member agrees to make payment in a timely manner. Member agrees to make the Birthbucks! Book available to their customers and clients at place of business (web or brick-and-mortar). The first 10 books are part of the member offer package. Additional books may be purchased for $10 each. Retail: $20/book. You can sell them, gift them, auction them and share them! Thanks for taking the time to fill out this form. We will be in touch with you soon!
Additional comments or INSTRUCTIONS