Local 1 Stop and Shop Small Business Retention Association Membership Registration Form

Welcome to the Small Business Retention Association (SBRA) powered by Local 1 Stop and Shop.

You were directed here because your business, business group or municipality/village has joined the Small Business Retention Association. The purpose of our association is to help existing small businesses stay in business through the Awareness, Mobility, and Promotion (AMP) process. Did you know through our A.M.P. service model we address the top 3 reasons Small Businesses go out of business according to the SBA (Small Business Administration). Reason 1. No Central Small Business Reference Point (People Don't Know They Exist), Reason 2.No Support for Questions to Be Answered and Resources to be Found, and Reason 3. Limited Experience/Knowledge on How to Create Business Attractiveness.

The AMP SBRA Membership Services:

Awareness Service:Small Business Centralization Reference Point online (business and consumer match tool) and in-print (distributed locally) to make businesses more easy to find year-round

Mobility Service:

Small Business Job Board to help fill business staff gaps (a central place for job openings to be found and to collect completed applications)

Promotion Service:Small Business promotion and coupon online directory to attract consumers year-round

The results of the SBRA Membership are:

Keeping existing businesses in the community, which is easier and less costly than recruiting new businesses
Enabling existing businesses to create 40% to 80% of new local jobs
Helping existing businesses provide proof of the economic viability of a community
Creating ambassadors of existing businesses content with their community

Through their membership you are now eligible to receive membership to the SBRA. To get started with your member services please complete our business enrollment form. This forms helps us collect all the business information needed to properly support your business across the A.M.P. process: A – Online and In-Print Centralization, M – Business Resource Matching, and P – Consumer Incentive Development. After completing the enrollment form we will contact you with your welcome kit and instructions on how to start using the AMP services to keep your business in business.

Complete the Membership Enrollment Form Below to start accessing your business services.

If you have any questions please contact us at 1-800-525-4072 or email us at ampprogram@local1stopandshop.com.

Submission Date

MonthDayYearHourMinutesAM/PM Option

Membership Group Enrolling Under

Other - Please Explain Here

Name of Membership Group Enrolling Under

Business Name

Business Owner Name

First NameLast Name

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Number

Area CodePhone Number

E-mail

Secondary Contact Name

First NameLast Name

Secondary Contact Phone Number

Area CodePhone Number

Secondary Contact E-mail

Business Name

Business Phone Number

Area CodePhone Number

Business E-mail

Business Type

Business Category

Hours of Operation

Business Website (If Applicable. If you don't have a website we will create you a basic free website, if you want a full website we charge $350. Contact us if you want a standard website and not a basic website.)

Client Facing Business (with physical address)

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Business Description - (provide 1-2 sentences that describe your business)

Price Range - (based on your business industry/competitors provide which price range your products and services fall within).

Business Featured - Name at least 2 other places your business is listed/featured (this helps credentialize your business. i.e., Facebook, Yellow Book)

Business Message - Provide a short message you would like to share with the public (hiring, new location/product, etc.)

Business Logo - Upload Business Logo (If you don't have a logo we will create you a free basic logo. If you want a professional custom logo designed we charge $50. Contact us if you want a professional logo.)

Upload a File

Business Slogan - (What is your catch phrase you use to describe your business. i.e.#1 Place to Find Local Businesses)

What is your immediate business resource need(s) (i.e, tax accountant, business insurance, funding source, etc.)?Will you use the business resource matching services to find resources you need year-round to help your business?

We also provide printing (bus cards, pluggers, etc.), graphic design, and consulting services. Please let us know if there is anything else we can help you with.

Will you use the Online Job Board included in the program to post open jobs?How often do you hire?

Other - Please Explain Here

Will you use the Staffing Assistance (Internship Program) in the program to provide positive youth opportunities and to help your business?

Other - Please Explain Here

Please provide more information below if you are looking for specific things that are not covered in our A.M.P. Business Retention Program

Coupon/Promotions/Events - (you must have at least 1 to run for 12 months to incentivize consumers).Please include Promotion Name and Value.

Promotion Restrictions

Have you used this promotion before?If so, was it successful?How many customers did you attract with this promotion if used before?

How many customers do you want to attract with this promotion?

Upload Coupon/Promotion Here

Upload a File

How would you rate the level of Awareness you have about your small business today? (i.e., how many people know about you and can find you easily)

	1	2	3	4	5

1 is Ok, 5 is Great

If you selected a rating 3-5, please provide what you do for Awareness and why it has or has not worked for you business?

How would you rate the level of Mobility based on your ability and/or access to use resources such as staffing assistance, online job board, and resource matching services to help support your business needs?

	1	2	3	4	5

1 is Ok, 5 is Great

If you selected a rating 3-5, please provide sources you have used for staffing assistance, online job board, and/or resource matching. Also tell us what you liked and did not like about the services.

How would you rate the level at which you use Promotions to attract customers and the return from creating these promotions?

	1	2	3	4	5

1 is Ok, 5 is Great

If you selected a rating 3-5, please provide the types of promotions you have used, promotion groups, and/or promotion channels and how well this worked or did not work for you? How frequent do you use promotions?

Payment Method

Insert 16 digit credit card number here (xxxx-xxxx-xxxx-xxxx):

Insert credit card expiration date here (i.e., 09/12):

Online Payment

SBRA Membership - Individual Level$300.00

SBRA Membership - Municipality Level (Prepaid by Municipality Parent Member)Free

SBRA Membership - Business Group Level (Prepaid by Business Group Parent Member)Free

Request Full Contract Details by Email (Sales@local1stopandshop.com).

Service Arrangements:
This agreement is required to obtain and maintain service with Local 1 Stop and Shop for business retention services, internet marketing, web advertising hosting, website creation/enhancement, shopping cart, or product delivery. This contract supersedes any written, electronic, or oral communication you may have with Local 1 Stop and Shop, and constitutes the complete and total agreement between the parties.
If any litigation or legal issues arise regarding services rendered by Local 1 Stop and Shop, or its associates, these will commence in the jurisdiction of Cook County, Illinois.
Acceptance of this Service Agreement is required for an account to be setup with Local 1 Stop and Shop.
By providing your down-payment for internet marketing, web advertising hosting, website creation, website enhancement, shopping cart, or product delivery, or other services, you indicate that you have read and understand this Service Agreement in its entirety, and agree to be bound by its content.
Failure of Client to comply with this Agreement, shall entitle Local 1 Stop and Shop to (1) terminate the clients account, or (2) suspend access of clients account. Violation of any of the conditions of this contract may result in the immediate termination of your services with Local 1 Stop and Shop.
Financial Arrangements:
a) Client agrees to this month-to-month Contract for hosted website or retention services, and establishes such Agreement by initiating an account to be set up for Client. b) Client will be billed on a monthly basis for Web hosting services and/or marketing services. A separate monthly hosting fee is payable in advance, on the first of each month, and shall be paid by credit card.
c) This Agreement will automatically renew for successive single month periods unless canceled in writing by Client, prior to the monthly renewal date. Renewal prices are subject to change. Renewal of services by Client indicates agreement to Contract revisions.
d) Payment of new Web site or Business Retention projects: Upon Clients approval of the Estimate provided by Local 1 Stop and Shop, Client agrees to pay in advance 50 percent of estimated project costs, and the balance paid in full of all real-life Web site project costs upon completion of project. This includes any expenses which exceed the costs in the Estimate. (For projects exceeding $1000, the Estimate balance can be set up in monthly payments* for project only.) Client will receive a receipt of payment from Local 1 Stop and Shop.
e) Additional Web site changes, or additional Internet marketing, will be charged to Client's credit card* for payment upon completion of changes or marketing work. Client will receive a receipt of payment from Local 1 Stop and Shop.

Signature acknowledges the acceptance of the terms and conditions of Local 1 Stop and Shop

Local 1 Stop and Shop Small Business Retention Association Membership Registration Form

Contact us at: 1-800-525-4072 or sbra@local1stopandshop.com

Primary Contact Information:

A.M.P. Awareness Section: The Goal is to Centralize your Business Online and In-Print

A.M.P. Mobility Section: The Goal is to Support your Business

A.M.P. Promotion Section: The Goal is to Grow your Business

Survey of Current Level of Business Awareness, Mobility, and Promotion:

Online Payment

Thank you for your business and enrollment into the Small Business Retention Association. Membership materials will be sent out in 3-5 days. Any questions please contact Local 1 Stop and Shop at sales@local1stopandshop.com or 1-800-525-4072.