Direct Shopper Coupon Club

1911 Grayson Hwy.
Suite 8-215
Grayson, GA 30017

770-906-1180
866-945-2171 (Outside of GA)



Tell us which of your favorite businesses
you'd like to see offering coupons on Direct Coupon Club
 
Simply provide as much information as you can in the form below.
 
We will contact YOUR FAVORITE BUSINESSES and offer them
the opportunity to advertise their coupons on www.thedirectshopper.com. 
GENERAL LIST OF BUSINESS TYPES
SELECT ONE OR MORE - TO INDICATE WHAT TYPES OF BUSINESSES (IN GENERAL) THAT YOU'D LIKE TO SEE MORE COUPONS OFFERED FROM.
APARTMENT RENTALS HOME (General)
AUTO - OIL CHANGE / LUBE<
  
Your Information
This is OPTIONAL (but Preferred). But we hope you'll share your name and information with us so we can send you a thank you note.
 Your Information (Optional)
First Name
Last Name
Street Address
City
State
*Your ZIP CODE
This field is REQUIRED. ( Example: 556600 ) Provide FIVE (5) Numbers Only - for your Zip Code!
Your E-mail Address
This is OPTIONAL. But we would like to be able to notify you by e-mail should your referred business join The Direct Shopper Coupons, as soon as their coupons become available.
Tell us some of your "favorite" businesses (REFERRALS)
 Business
Name
 Location
(Street, City, State)
 Phone Number
(if known)
 Contact Person
(if known)
Favorite Business (1)
Favorite Business (2)
Favorite Business (3)
Favorite Business (4)
Favorite Business (5)
Favorite Business (6)
Favorite Business (7)
Favorite Business (8)
Favorite Business (9)
Favorite Business (10)
Comments
Please let us know if you have any special or additional comments, suggestions, etc.


If you experience any difficulty when completing this form, please contact the webmaster at info@thedirectshopper.com

or call 770-906-1180 866-945-2171 (Outside of GA)