HDT Business Partners Gift Card Incentives Application

HDT Business Partners Gift Card Incentives Distribution Agreement

My business is an HDT Business Partner in full compliance with the HDT Partners program requirements.
My business will not redeem any gift card for age-restricted goods or services.
My business will selectively distribute gift cards to employees and customers as rewards for excellent public health practices and/or public health messaging.
Gift card distribution will be maximized to ensure the greatest number and most deserving employees and customers are recognized and rewarded.
Gift cards will not be distributed to multiple members of the same household during a single visit.
Gift cards will not be distributed to family members of ownership/management.
My business will encourage customers that are gift card recipients to take a short survey at the time the gift is provided (making a provided QR code available for customer to scan on their mobile device)
My business will provide monthly documentation of gift card distribution and redemption to HDT Partners.

Business Name*
Business Address*
Street Address Address Line 2 City ZIP Code
Primary Business Phone Number*
Owner Name*
Owner Contact Phone*
Owner Email*
Are you an HDT Business Partner in good standing?*
- Yes
- No
Are you applying to sell gift cards (or equivalent), receive gift cards (or equivalent) to distribute as incentives, or both?*
- Sell gift cards
- Receive gift cards
- Both
Does your business sell goods (please describe range by type and cost)?*
Is your business primarily service-oriented (e.g. professional such as attorney or doctor; construction; home service or repair; hair salon)? Provide details*
Does your business sell age-restricted goods/services (explain)?*
Do you have an existing gift card or equivalent system (explain and provide example)?*
Approximately how many customers and/or employees (specify which) do you have on-site in a day (provide high, low, and typical)?
By signing below, I attest that the information I have provided above is true and correct, and I agree to comply with the gift card distribution requirements as identified above:
Authorized Business Representative*
First Last
Title*