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) Title Primary 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 Address City State Zip Membership 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. *Third party operators with multiple locations do not qualify for this fee schedule. Contact our office for details and application process.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 (unless canceled by PPP). 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)* I understand that Purchasing Power Plus discounts cannot be combined with any other offerings and regular exclusions still apply. You are free to select the best offering for you. (Typing your name is equivalent to a digital signature for the purposes of this document)* I have read and agree to all Terms of Service Agreement. Type Initials for Agreement* https://purchasingpowerplus.com/memberterms/Membership Application Signature of Agreement (Typing your name is equivalent to a digital signature for the purposes of this document.)* Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.