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Thank you for your interest in iLocalFlorist.com.

Instructions: To apply, print the membership application, please answer the questions, mail membership application with a check for annual dues. (Annual dues of $75 cover the first 15 zip codes.There is a $5.00 fee for each additional set of 15 zip codes.)

Date ________________

MEMBERSHIP APPLICATION

Basic Information    
Business Name:
__________________________________________
Address:
__________________________________________
City/State/Zip:
__________________________________________
Local Phone:
______________________________  
 
Owner Name:
__________________________________________
Contact Name:
__________________________________________
Contact Email:
__________________________________________
Fax Number:
__________________________________________
Toll-Free #:
______________________________  
Website URL:
______________________________  
Business Email:
______________________________  
 
Primary Zip
(1)_________*Where your shop is located
Secondary Zips
(2)_________  (7)_________  (12)_________
(3)_________  (8)_________  (13)_________  
(4)_________  (9)_________  (14)_________  
(5)_________  (10)_________  (15)_________  
(6)_________  (11)_________
 
 
Length of Membership:    12 months

Annual Dues Only $75, (around $6.00 per month!). Listing includes up to 15 zip codes. Add $5.00 for each additional group of 15 zip codes.

Make check payable to iLocalFlorist.com

Print form and Mail To:

iLocalFlorist
11907 Dunlap
Houston, TX 77035


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