VALIDATION PROGRAM ENROLLMENT FORM
SmartPark Validation Program
Enrollment Form
Merchant/Business Name
Merchant Address
(Street)
(City)
(State)
(Zip Code)
Primary Contact Name
Email Address
Alternate Contact Name
Email Address
Billing Address
(Street)
(City)
(State)
(Zip Code)
My Billing Address is the same as my merchant address.
/
/
/
Primary Business Phone
Alternate Phone
Fax Number
Business Email Address
Primary Validation Policy
All Customers
Minimum Purchase
Select Customers
Employee
(For informational purposes only)
I accept the
terms and conditions
of the merchant validation program.
