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