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1
Location = $
250
/year
Organization Name
*
Address
*
Address 2
City
*
State
*
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California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
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Hawaii
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Contact First Name
*
Contact Last Name
*
Contact Title
*
Contact Phone
*
New Location #1
*
indicates a
REQUIRED FIELD
Location Name
*
Business name in the app
Corporate Name
*
Business Description
*
Marketing Website
Address
*
Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Location Contact Name
Location Phone
*
Location Email
Business Category
*
Select a Primary Category
Accounting, Tax Services
Activities
Advertising
Airlines
Associations
Attorneys
Automotive
Barber shop
Bicycle/exercise shops
Boats and boat accessories
Books stores/Authors
Building
Cellular
Chambers
Charity
Churches
Cleaning services
Computers/tech services
Consulting
Convenience- gas, fuel, food
Discount Groups/Clubs
Dry cleaning/laundry
Education
Electronics
Entertainment
Financial Services
Fitness and Exercise
Flowers
Foods/specialty
Furniture
Gifts
Groceries
Guns/firearms
Health, Wellness and Sports/Fitness
Home/Commercial services/repairs
Homes for Heroes
Insurance
Kids, Babies and Toys
Lodging
Manufacturing
Martial Arts/Self Defense
Maternity
Men's Apparel
Men's Shoes
Motorcycle - ATV Dealer
News & Media
Office Supplies/Printing
Online Retailers
Organized Sports
Outdoor gear
Pet Companies
Pharmacy
Portrait Studios
RV/Camping
Real Estate
Rental Cars
Restaurants
Retailers
Salon
Shipping and Delivery
Tools and Hardware
Travel
Women's Apparel
Women's shoes
Select a Secondary Category
Defender Discount Percentage
*
Discount Percent Given to Defenders
Defender Discount Exceptions / Disclaimers / Notes for App
*
Location Image
*
Contact Email Address
*
(Used as username)
Password
*
Case Sensitive
Confirm Password
*
Case Sensitive
Group Code
Apply Code
Select Your Plan
*
$500/year
Card Number
*
MM
*
YY
*
CVC
*
Billing Zipcode
*
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