Connections Card Form

Co-op Connections Member Benefit Program Participation Agreement

Date: *

Name of Business: *

Business hours: *

Business Description: *

Contact Name & Title: *

Category: *

Business Address: *

Mailing Address (if different from above):

Location discount honored:

All Locations

Email Address: *

Discount Offer: *

Exclusions:

Terms and Conditions:

I agree to participate in Duck River Electric’s Co-op Connections Member Benefit Program by offering product or service discounts to all Co-op Connections cardholders. I have elected to offer the discount listed above and agree to honor this discount for 12 months unless Duck River Electric Membership Corporation terminates this contract. This agreement is effective from the date listed below. The contract will automatically renew after 12 months and the promotion can be updated at any time after the initial 12 months. At the end of 12 months, I may extend, amend or discontinue my offer.

Date: