Local 10s Merchants

Statement of Authority
By providing the information below, selecting the "Statement of Authority" button, and clicking to submit this form, I acknowledge that I am an authorized agent for the Business Name and Owner Name; that the business is *independent, Locally Owned and Operated (i LOO); that any misrepresentation here is cause for suspension and/or expulsion; and that any affiliated business (eg., Jones Meats/Jones Meats II/Jones Meats Eastside), can and will honor the same terms to which I declare now; and that I have read, understood and agree to the Terms & Conditions as published on the Local On The 10s website (http://local10s.com).

* i LOO is defined as a business owner & operator, having no affiliation with or dependency on, any other "parent" company; and acts as no affiliate with or "parent" company to, any other business owner using the same Business Name. The quick litmus test is if you can say this about your business: "My business, [YOUR BUSINESS NAME HERE], would not even exist if not for me".
* indicates required
The name customers know you by, "Doing Business As".
if the business is owned / operated by an entity other than the D/B/A
State where business is registered. If not registered, state where most of your business happens.
Current license only.
Current license only.
Please re-read "Statement of Authority" if not sure.
Please re-read "Statement of Authority" if not sure.
Your business' physical address. If you go to the customer, please provide a billing address.
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