Current Introduction Signature Complete As a business participant in our Co-op Connections Card program, you understand that your signature on this contract is your agreement to be an active participant in this program. You agree to uphold the offer/ discount explained below to all cooperative members who show their coop connections card until notification to FreeSta te Electric Cooperative is made thirty days before the desired participation end date. In return for your participation, FreeState offers the following benefits in our efforts to support our local businesses: A listing (with a logo if provided) on our website under the Programs tab https://freestate.coop/connections The opportunity to expand your business reach throughout our service territory and more Business Contact First Name Last Name Contact Email Business Contact Information Business Website Contact Company Phone Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Mailing List Please subscribe me to the partner mailing list. Discount Offered Describe your discount Please describe what special offer or discount your business will be offering to FreeState's members when they show their Co-op Connections Card: Please provide a value. If no value is listed a default of 10 will be assigned. Value of Discount in Dollars $ Date Discount Begins Date Discount Ends I have multiple offers Describe other offers, and include dates CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Next Page >
