Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Company Name *Company Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWill more than one location participate? *YESNODISCOUNT BEING OFFERRED: Please note: The following disclaimer will appear on all discount card printed under this agreement. "Valid for cardholder only / Present card when ordering / Not valid with other sales or discounts / Equal or lesser value always applies / Offers may vary / Good only at participating locations / One card per visit/table" PERCENT OFFCompany PhonePrimary Contact *FirstLastContact Phone *Contact Email *PERCENTAGE OFF10%15%20%25%OTHEROTHER PERCENT OFFPERCENT DISCOUNT APPLIES TOANY PURCHASEMENU ITEMS ONLYREGULAR PRICED ITEMSOTHERDISCOUNT APPLIES TO (OTHER)AMOUNT OFFBUY 1 GET 1$_____ OFF PURCHASE OF $_______OR HIGHERBUY ONE__________GET ONE FOR ____________FREE ITEMOTHER DISCOUNTPLEASE DESCRIBE IN DETAIL THE FREE ITEM: (i.e. "Free gift certificate with test drive")PLEASE DESCRIBE YOUR OFFER EXACTLY AS IT IS TO APPEAR ON TEH CARDAUTHORIZATION: There is NO CHARGE for participating in the EACC Discount Card Program. This card is being offered to EACC members as a benefit of their membership in the organization. The discount at your business will be valid for one year, from May 1, 2026 through May 1, 2027. In order to maintain the quality of the program, you are expected to honor this existing cards/discounts until the expiration date. By signing below, you agree to participate and that you have the authorization to approve this agreement. Authorized by: (print name below) *Signature * Clear Signature Date DateTimeADDITIONAL LOCATIONS: Please list additional locations participating under this agreement. The discount must be the same for all locations. If a location is offering a different discount then a separate agreement must be completed. Location 1 Comapny NameContact NameAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail * Location 2 Comapny NameContact NameAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail * certificate Primary TO Location 3 Comapny NameContact NameAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail * Location 4 Comapny NameContact NameAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail * Education Association of Charles County 105 Centennial Street, Suite H, La Plata, MD 20646 Ofice: 301-392-0150 / Fax: 301-392-0151 / [email protected] NextUpdating preview…This is a preview of your submission. 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