Retail Alliance / LOVEVA Membership Application Form

I. ACCOUNT DETAILS

Business Name *

Date *

Business Phone *

Website / URL (or social media link) *

Business Location Address (for public Member Directory)

Address Line 1

Address Line 2

City

State

Zip Code

If you do not have a storefront, please put in PO Box or leave blank

Mailing Address (if different to above)

Address Line 1

Address Line 2

City

State

Zip Code

Choose category for your business *

Choose subcategory for ADVERTISING/MARKETING/MEDIA

Choose subcategory for APPAREL & ACCESSORIES

Choose subcategory for ART

Entertainment
Art Gallery
Photographer
Specialty

Choose subcategory for ASSOCIATION & NON-PROFIT

Association
Non-profit

Choose subcategory for AUTOMOTIVE

Dealer
Parts
Service

Choose subcategory for BUILDING/GARDEN SUPPLIES & SERVICES

Choose subcategory for FINANCIAL SERVICES

Choose subcategory for GROCERY & FOOD

Convenience Store
Market
Specialty Food & Beverage
Supermarket

Choose subcategory for HEALTH/FITNESS & MEDICAL

Choose subcategory for HOME

Choose subcategory for HOSPITALITY

Choose subcategory for INSURANCE

Health
Property

Choose subcategory for IT PRODUCTS & SOLUTIONS

Communication
Electronic/Computers

Choose subcategory for MEMBERSHIP CLUB & DISCOUNT STORES

Discount
Membership Club

Choose subcategory for OFFICE SERVICES & SUPPLIERS

Equipment & Service
Mailing Service & Supplies
Notary, Stamps & Seals
Supplies

Choose subcategory for PERSONAL CARE & SERVICES

Dry Cleaning
Salon
Spa/Massage
Tattoo Parlor

Choose subcategory for PRINT & CUSTOM SERVICES

Awards/Engraving
Certificates
Printing & Signage

Choose subcategory for PROFESSIONAL SERVICES

Choose subcategory for SECURITY SERVICES

Guards & Services
Systems

Choose subcategory for SPECIALTY RETAILER

II. CONTACT DETAILS

Business Owner Name *

Owner's Direct Phone or Cell Phone *

Email *

Check relevant boxes for business owner

Primary Contact
Billing Contact
Marketing Contact
Click here if you wish to receive paperless communication

Manager Name

Direct Phone or Cell Phone

Email

Check relevant boxes for manager

Primary Contact
Billing Contact
Marketing Contact
Click here if you wish to receive paperless communication

Additional Contact Name

Direct Phone or Cell Phone

Email

Check relevant boxes for additional contact

Primary Contact
Billing Contact
Marketing Contact
Click here if you wish to receive paperless communication

III. LOVEVA PROGRAM ELIGIBILITY

If you would like to participate in LOVEVA, you must be able to click on all the choices below to qualify

I sell to consumers, not to businesses
Are decisions made locally as it relates to advertising, marketing, community engagement, charitable donations, purchasing, legal, etc?
Do business owners who have controlling interest of more than 50% live in Hampton Roads?
Is the business privately held and not publicly traded?

I clicked on all 3 qualifying questions above

I clicked on all 4 qualifying questions above

Select One

Local independently owned business
Locally owned franchise (franchises will be noted as "Locally Owned Franchise" in the listing)

Company Name as you'd like it to appear on the LOVEVA app

Please provide a short description that best represents your business (500 characters or less on app)

This description will be listed on the LOVEVA app and on the website.

Business Hours (write Closed or the nearest hour that your business opens and closes each day or check By Appointment Only below

These hours will be listed on the LOVEVA app and on the website.

By Appointment Only Checkbox

OR By Appointment Only

Your Business Local Impact Icons *

Icons will represent your business on the LOVEVA app and on the website. Choose maximum of 3.

Business Reward for Frequent Shoppers *

What kind of reward will you offer customers who have earned 5 hearts? This could be an item or a percentage off, such as 20% off (check out app for examples). Limited characters in this section.

Business Reward Description *

Please give detailed/fine print description about your reward to be included in your listing.

Social Media Handles (to link from app/website)

Include all the social media handles you want to be included in your listing.

IV. MEMBERSHIP PRICING

If you are unsure which membership level to choose, we typically refer to the Census description of retail: Retail Trade, as defined by NAICS sectors 44-45, includes establishments engaged in selling merchandise in small quantities to the general public, without transformation, and rendering services incidental to the sale of merchandise. Details of inclusions for each level are outlined on our website at retailalliance.com. Please check the membership level you are interested in. *

If Non-profit checked above, please upload your proof of 501c3 status

Click or drag a file to this area to upload.

If Co-Op Tenant checked above, please provide name of Co-Op Partner

If extra LOVEVA branches required, please mark quantity (above & beyond the original primary member location)

$ Total = (Membership Level Price) + (No. of LOVEVA Branches x $25)

Once this application form is received, an invoice will be emailed to you for payment. All memberships paid by credit card are automatically renewed annually with 30-day notice of charge prior to renewal. If you do not wish to auto renew membership, please check box below.

Checkboxes

Do not auto-renew

V. AGREEMENT

By completing the section below, you are agreeing to the Terms & Conditions in Section VI and that you have the authority to make decisions on behalf of the Organization outlined in the Application. You also agree to the LOVEVA merchant terms and conditions and privacy policy located online at bealocalloveva.com.

Name of authorized representative *

Title *

VI. RETAIL ALLIANCE & LOVEVA MEMBERSHIP TERMS & CONDITIONS

Click link below to refer to the terms and conditions of membership.

Click here for Terms & Conditions of Membership

How did you hear about Retail Alliance / LOVEVA?

So we know you are not a computer bot, please complete the Captcha math equation below *

What is 11+4?

Signature