Become a Local App Partner

Participation Authorization

Choose the option below to continue with the correct form path.

Please complete the parent entity questions below and then submit the form.

2. Is Parent Company a Corporation/Franchise with Retail Locations?

Yes

If Yes, do their retail locations need parent entity participation approval?

Yes

Up To Location

Participation Restrictions

3. Is Parent Company a Larger Association/Organization that Oversees Individual Groups?

Yes

If Yes, do their associated groups need parent entity participation approval?

Yes

Up To Group

Participation Restrictions

4. Parent Entity Information

Parent Entity Name

Entity Type

Contact Name

Contact Number

Required Information For Verification

Provide the organization details for verification review.

Business

Entity Type

Primary Contact Name

Contact Email

Contact Phone

Website (Optional)

Agreement & Signature

Review and confirm the information being submitted.

I certify that the information provided is accurate and that I am authorized to submit this verification. I understand that false information may result in denial of participation or removal from the program.

I agree to the terms and certify that the information above is correct.

Full Name (Signature)

Date

Portal Credentials

Create your login credentials to access your portal.

User ID

Choose a unique username.

Password

Confirm Password

Password must be at least 8 characters and include a number or special character.

Authorized Verification Sponsor

If an authorized sponsor is present, this section should be completed by the sponsor.

Sponsor Phone

Sponsor Email

Sponsor Name

Sponsor Title / Role

Verification Notes

Authorization & Verification form

Participation Authorization

Required Information For Verification

Agreement & Signature

Portal Credentials

Authorized Verification Sponsor