1. Pre-Application
This application is subject to review and approval
Fax: (770) 305-0080
Email: applications@qnanza.com
Business Information:
Business Name: Street Address, City, State, and Zip:
Business Website: Business Phone: Business Email:
Customer Contact Information:
Name: Phone Number: Email Address:
Best Time To Be Reached: Please provide a specific time frame, such as Monday and Tuesday 1-3 PM. Times are in EST. Example if
you choose 9 AM - 11 AM and you are in PST, you will receive a call between 6 AM and 8 AM PST.
Times: Days:
9 AM - 11 AM 11AM - 1 PM 1 PM - 3 PM 3 PM - 5 PM Monday Tuesday Wednesday Thursday Friday
Outside patio We have the We offer the Only red light We have been
dining with full newest deluxe newest body therapy bed in rated the top
view. spa and sculpting and town.
pedicure chairs laser techniques camp, 3 years
Highlight Examples: in town. available. running.
Highlight: Please list what sets your business apart. See examples above.
Shampoo, hair-cut, and blow- $59 for dental cleaning, exam, $20 for $50 worth of food and
Offer Examples: dry for $55. ($133 value) and x-rays. ($305 value) beverages, excluding alcohol,
at ABC Restaurant.
Offer: The face value of your coupon must be a minimum of $15 and be discounted by at least 50% off the retail value. Your offer must
be in even dollar amounts only, for example your offer cannot be $30.95. Your offer must include retail value, discount value, and the
goods/services being offered. Discounts cannot be applied to the sale of alcohol.
Retail Value:
Discount:
Expires December 31, 2011. Limit Limit 1 coupon per table. Dine- Coupon not valid with any
Fine Print Examples: 1 coupon per person, per visit. in and carryout only. other offers.
Fine Print: Please include the fine print of your offer.
New Customer Expectations: Please provide a reasonable estimate of NEW customers your establishment can expect to service each
peat customers.
It is not our intent to strain your existing resources;; this initiative is meant to grow your business at a pace pleasurable for customers and staff.
Qnanza Pre-Application Page 1 of 2 05.27.2011
2. I understand for my application to be considered my offer must be a discount that is 50% or greater.
I acknowledge if my application is approved, I will receive 50% of the voucher purchase upon sale according to the terms of the contract.
I acknowledge if my application is approved, I am agreeing to a 3 month minimum contract with Qnanza. (One time events excluded.)
I understand if my application is approved, I must honor a minimum of $1,500 in coupons per month. Monthly maximum number of
coupons times the coupon sales price must equal or exceed $1,500.
I understand if my application is accepted, there will be a $100 set up fee that will be deducted from my first months coupon sales.
Example, $1,500 worth of coupons are sold each month. The business owner will receive $650 the first month and $750 all months thereafter.
Setup will be waived if my offer is discounted by 60% or more.
Signature: Date:
Rep Information:
Name: Rep ID: Email: Phone:
Raul Duenez info@socialmediascouts.com 818-308-5893
125463
Fax: (770) 305-0080
Email: applications@qnanza.com
Qnanza Pre-Application Page 2 of 2 05.27.2011
