C4 Member Business Network Application Business InformationPlease provide your business' name/title.*Business Address/Location Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code This is the address that you would like listed on the newsletter and sponsorship website page.Company Website Social Media Links and Tags This can include your Facebook, Twitter handle, and Instagram information. Please list as many as you would like included for the newsletter header. Please add as many as you would like. Contact InformationIndividual for Contact* First Last Contact Email* Contact Phone NumberDiscount & Newsletter InformationWhat is the discount your business is offering to our members?*Please make sure to specify all details that you find important for this discount. Examples include: one time uses; specific days of the week for redemption; maximum discount offered; one per personDo you have a preferred month for the newsletter header? If so please specify below. (July 2015 - June 2016)Company Logo*Please make sure the image is at least 600 DPI and in a JPG file format.