Membership Application Please complete our form to activate your Purchasing Power Plus Retail Membership and join our community of Healthcare Gift Shops:Primary Contact Person (Include First and Last Name)*Title*Secondary Contact Person (Include First and Last Name)TitlePrimary Contact Phone #*Primary Contact Fax #Secondary Contact Phone #Secondary Contact Fax #Primary Email Address* Secondary Email Address Corporate Name (Hospital, Pharmacy, Facility...)*Bed Size (When Applicable)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. 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 Corporate 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 32771Join us, as we move towards a more environmentally sound approach to community and connection. Opt for the digital copy of our Printed Quarterly Packet.* Yes No Purchasing Power Plus offers identifying labels upon request. These labels include your Gift Shop Name and PPP Retail Number. Please indicate if you would like to receive a set.* Yes, I would utilize labels for paper/fax orders. No, I do most of my ordering digitally. I understand and agree that my data (including email) will be shared with PPP partners and markets, so that you may be notified of their product/service offerings directly. Type Initials for Agreement*I understand that all Membership Fees are nonrefundable and cannot be pro-rated under any circumstance. An annual membership is required to ensure a program of integrity for our Retail Community. (Typing your name is equivalent to a digital signature for the purposes of this document)*Membership Application Signature of Agreement (Typing your name is equivalent to a digital signature for the purposes of this document.)*Date* Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.