Request Store Consideration

I am a shopper who knows of a great store to include in the village.
I am associated with this quality store and I'd like to see it included in the village.

Name of on-line store:

URL (Web address) of on-line store:

List categories of items (e.g., sporting goods, women's clothing, toys, music, electronics, appliances, jewelry, etc.):

Detailed description of store (include marketing pitch, financial info, and reasons why it should be included):

(Store associate's only) The store provides affiliation services

(Store associate's only) Does the store provide better-than-posted affiliation benefits (explain below)?

(Store associate's only) What are the details of your affiliation services (include URL of your registration form or phone number of the primary affiliation contact):

(Store associate's only) Please supply us with contact information regarding the store's management (names, e-mail, address, phone):

What is your name? (optional)

What is your e-mail address? (optional)

Any additional comments about why we should include the store?