Membership Application Please complete our form to activate your Purchasing Power Plus Retail Membership and join our community of Hospital Gift Shops:Primary Contact Person*Title*Secondary Contact PersonTitlePrimary Contact Phone #*Primary Contact Fax #Secondary Contact Phone #Secondary Contact Fax #Primary Email Address* I agree to provide my Email Address to all PPP Vendor Partners* Yes No Go Green: Opt for a Digital Version of our Monthly Packet* Yes No Secondary Email Address Hospital Name*Bed Size*Gift Shop Name*Mailing Address*City*State*Zip*Gift Shop Phone Ship to Address is the same as the Mailing Address Different Ship to AddressCityStateZipMembership is for a 12 Month Period. A savings spreadsheet is available, so you may track and ensure discounts throughout the year. PPP has no knowledge of savings data. Our Membership fee is non refundable and fee cannot be prorated. Renewals are not automated and can be completed annually online or via mail. PPP Retail Members will receive regular email updates relating to Membership; however, we do not provide your email addresses to any third parties without your consent. Each individual Gift Shop being shipped merchandise must have a PPP Retail Membership. Gift Shop parties agree to only request the PPP discount for eligible locations with an active PPP Retail Membership. Additionally, PPP Retail Membership is based on your Hospital Name, Gift Shop, Bill To and Ship To Address. This information must match our records to qualify for the PPP discount. Mail check payments to - Purchasing Power Plus, Attn: Member Team, 5224 West State Road 46 #337, Sanford, FL 32771Signature of Agreement (Typing your name is equivalent to a digital signature for the purposes of this document.)*Date* NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.