When you finish completing this on-line form, a representative will contact you to verify your information. By submitting this form, you agree to the terms & conditions listed on our member agreement page (which can be seen by clicking here ). Upon completion of this preliminary application, DiningCertificates.com will review and verify your info. A representative will contact you by E-mail to confirm receipt of your application and provide you with information regarding when you can expect to receive your "Member's Kit" which will include everything you need to begin selling Dining Certificates on-line and tracking certificates that have been issued and redeemed.

Restaurant Contact Information
Your Full Name:
Restaurant Name:
E-Mail Address:
Phone: (include area code)
Type of Cuisine:
Website Address: (optional)
Restaurant Address:
City, State: ,
Zipcode:
Short Description:
(optional)
Promo Code (optional):