Motivano SmartSavings Merchant Referral Form
Please complete form and return to referrals@motivano.com Merchant Responses Client Name Merchant Name
Local Merchant or National Merchant
Location(s) (please indicate all locations) Type of Product
Brief Description of Your Company (255 character including spaces)
Discount Offer (Must be entered for processing) Discount Offer redeemed by way of? (ex: submit Client id or coupon) Expiration Date
Contact Info (Please included name, address, phone and email) Website
Prior relationship with this client? (Y/N) If yes, please send agreement form pertaining to this.
Are you interested in offering the promotion to all Motivano clients? (if not enter client name)
Additional information