Retail Alliance Membership Application Form

- Step 1 of 4

Date *

I. ACCOUNT DETAILS

Business Name *

Business Phone *

Website / URL (or social media link) *

Month and Year Business Opened

Not open yet

Business Location Address (use PO Box if no physical location) *

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

Business Logo Upload

Click or drag a file to this area to upload.

Minority Group(s) (choose any that apply)

LGBTQ-owned
Minority-owned
Veteran-owned
SWam (Small, Women-owned & Minority-owned) certified
Women-owned

Choose category for your business *

ADVERTISING/MARKETING/MEDIA
APPAREL & ACCESSORIES
ART
ASSISTED LIVING & SENIOR SERVICES
ASSOCIATION & NON-PROFIT
AUTOMOTIVE
BUILDING/GARDEN SUPPLIES & SERVICES
DEPARTMENT & GENERAL STORES
EDUCATION
FINANCIAL SERVICES
FUNERAL SERVICES
GOVERNMENT
GROCERY & FOOD
HEALTH/FITNESS & MEDICAL
HOME
HOSPITALITY & ENTERTAINMENT
INSURANCE
IT PRODUCTS & SOLUTIONS
MEMBERSHIP CLUB & DISCOUNT STORES
OFFICE SERVICES & SUPPLIERS
OIL
PERSONAL CARE & SERVICES
PRINT & CUSTOM SERVICES/SIGNAGE
PROFESSIONAL SERVICES
REAL ESTATE/PROPERTY MANAGEMENT/BUSINESS CENTER
SECURITY SERVICES
SHOPPING CENTER
SPECIALTY RETAILER
TRANSPORTATION SERVICE
WHOLESALE

Choose subcategory for ADVERTISING/MARKETING/MEDIA

Advertising
Creative Services
Marketing
Media
Promotional Products
Video
Web Solutions

Choose subcategory for APPAREL & ACCESSORIES

Clothing
Consignment
Men's Clothing
Shoes
Specialty Clothing
Thrift
Women's Clothing & 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

Construction Supply
Contractor
Electronic Contractor
Heating & Air Conditioning/Plumbing
Landscaping/Lawn & Garden/Ponds
Lumber & Hardware
Pest Control
Plastics

Choose subcategory for FINANCIAL SERVICES

Bank
Collection
Credit Union
Financial Planning
Investment

Choose subcategory for GROCERY & FOOD

Convenience Store
Market
Specialty Food & Beverage
Supermarket

Choose subcategory for HEALTH/FITNESS & MEDICAL

Gym
Hospitals & Clinics
Medical Supplies
Optical Store
Pharmacy
Physician/Dentist
Wellness/Nutrition
Veterinarian

Choose subcategory for HOME

Antiques
Appliance & Equipment
Entertainment
Flooring/Cabinetry
Furniture
Home Contracting
Interior Design
Pool/Spa/Supplies
Upholstery

Choose subcategory for HOSPITALITY

Arena
Brewery/Winebar
Entertainment/Recreation
Hotel
Museum/Museum Shop
Rentals
Restaurant/Caterer
Theatre
Venue

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

Accounting
Auction
Commercial & Residential Cleaning
Commercial Maintenance
Consulting
Credit Card Processing
Employment & Staffing
Legal
Movers/Storage
Payroll & HR Solutions
Research Facility
Restoration
Tax Services
Travel
Uniforms

Choose subcategory for SECURITY SERVICES

Guards & Services
Systems

Choose subcategory for SPECIALTY RETAILER

Beauty Products
Bookstore/Comics
Farm Supply
Garden/Florist
Gift Shop/Artisan Market
Jewelry
Kids/Toy
Knitting & Yarn
Marine
Music
Pawn Broker/Firearm
Pet/Wildlife Supplies & Services
Sporting Goods
Tobacco/Cigar/Vaping/CBD
Wine/Beer/Spirits

II. CONTACT DETAILS

Business Owner Name *

First

Last

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

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

Check relevant boxes for additional contact

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

III. MEMBERSHIP PRICING

Membership Levels

Retail (1-5 employees) - $ 195.00
Retail (6+ employees) - $ 295.00
Retail Partners (1-5 employees) - $ 225.00
Retail Partners (6+ employees) - $ 325.00
Branch membership (additional Retail locations receive full benefits of membership) - $ 145.00
Branch membership (additional Retail Partner locations receive full benefits of membership) - $ 175.00
Signature Partner - $ 700.00
Premier Partner - $ 1,250.00
Co-op Partner - $ 1,250.00
Co-op Tenant (Retail) (enter Co-op Partner below) - $ 145.00
Co-op Tenant (Retail Partner) (enter Co-op Partner below) - $ 175.00
Non-profit (501(c)3) (must provide proof of 501c3 status) - $ 150.00
Trade Membership (variable) - $ 0.00

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

Total

$ 0.00

Authorize.Net

Card Number

Expiration

Security Code

IV. AGREEMENT

By completing the section below, you are agreeing to the Terms & Conditions in Section V and that you have the authority to make decisions on behalf of the Organization outlined in the Application. Membership is not active until payment received.

Name of authorized representative *

Title *

V. RETAIL ALLIANCE 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?

Signature

Once you have completed the form, click Submit and one of our membership advisors will be in touch with you asap.

Website