Name of Business(Required) Category of Business(Required) Automotive Entertainment Fitness Florist Health/Beauty Healthcare Lodging Photography Recreation Remodeling Restaurants Retail Service Technology Tourism Contact Name(Required) First Last Title(Required) Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Business Description and Hours of Operation(Required)Website Link Consent(Required)By signing this contract I agree to be a participating Co-op Connections business and will give discounts to all Co-op Connections Cardholders as noted in the Co-op Connections brochure. I can provide whatever discount I want, as long as it is something that provides a real economic value to Cardholders. I have chosen the discount described below. I will continue to offer this discount (or a better discount) for one year, unless Touchstone Energy or my local cooperative, Golden Valley Electric Association, terminates this contract. This Contract is effective from the date signed until March 1 of the following year. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Electronic Signature (Full Name)(Required) After Golden Valley Electric Association receives your signed contract, we will mail your participating Co-op Connections package, which includes window and cash register stickers to display in your business to help identify you as a participating business. Please indicate how many window stickers and cash register stickers you need.Number of Cash Register StickersNumber of Window StickersCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
