i-card Perks Merchant Enrollment Application Form

Enrollment Application

Contact Information

Merchant name

Authorized agent or contact

Phone number

Email address

Website address

Participating Location

Only businesses and units in the local area are accepted.

Street address

City

State

ZIP code

Merchant Mailing Address

Check if same as above

Street address

City

State

ZIP code

Discount Information

Provide a brief description of your discount offer. If your discount is available at more than one location, add additional addresses here.

Who is eligible to receive the discount? (check all that apply)

Students

Faculty/Staff

Retirees

By checking this box, you warrant that you have read and accepted the i-card Perks Program Terms and Conditions. You agree to provide all the necessary information to have your product or service listed on the i-card Perks website. Failure to provide all such information could result in a delay in processing your form. You agree to provide written notification to the i-card Programs office about discontinuation, manufacturer recalls or any other information about your product or service that may not meet the mission and values of the University of Illinois.