Merchant Affiliate Master Application

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Official MarketPlace Merchant Application

Step 1. Fill Out this Form. Then Click Submit for Steps 2-4

Your DHS Club Member ID
(If you do not have an ID Number, one will be assigned)
Referral ID
Personal First Name
Personal Last Name
Personal Email Address
Name of Business
Address of Business
City
Country
State/Province   Use standard abbreviations.
Postal Code
Business Phone Number
Business Fax Number
Business Email Address
Business Website Address (URL)
You must choose your Business Type from these categories . Search Business Categories
Type of Business
Create a Username
Create a Password
Contact Name


Select the Merchant discount you wish to offer:
Membership Type Description Total Discount Rebate % Referral Fee Pay Points % SIAM % Your Choice
Bronze 3% 2% ¼% 3/8% 3/8%
Silver 6% 4% ½% ¾% ¾%
Gold 10% 6% 1% 1 ½% 1 ½%
Platinum 15% 10% 1 ¼% 1 7/8% 1 7/8%
Special Exception* Negotiated TBD TBD/NA TBD/NA TBD
See Below

* You will have the opportunity to submit your Special Exception request on the hard copy of the form you will have to send to us.


Account Holder's Information
Name
Address
City
Country
State/Province
Postal Code
Payment Method     (NOTE: Checking Account option is only available in the US.)                 
Credit/Debit Card Number
Example: (123456789012 no spaces)
(Debit Cards must have a Visa or MasterCard logo on them)
Credit Card Code    Card Code Help
Credit Card Expiration Date Month Year
                      - OR -                     (REMINDER: Checking Account information is only valid in the US.)
Checking Account Number
Example: (123456789012 no spaces)
Bank Routing Number
Example: (123456789 no spaces)
You will be required to submit a voided check or facsimile thereof with your application if you choose to pay by check.