Employee Discount Form

	Company Name*

	Category*
	--Please Select--Automobile Care and ServiceAutomobile Dealers-New CarsAutomobile Dealers-Used CarsAutomobile InsuranceBanking ServicesBeauty Salon and ServicesCaterersChild CareChildren's ClothingChiropractorCleaning ServicesComputer DealersComputer Service and RepairCosmeticsDebt ConsolidationDentalDepartment Store/Retail SalesDining and Meal PreperationExercise and Physical FitnessFinancial ServicesFloristGiftsGroceryHealth ClubHome Care and MaintenanceHome Equity LoanHome ImprovementHomeowners InsuranceHotelHouse CleaningLandscapeLawn and GardenLife InsuranceMeal Assembly KitchenMen's ApparelMold Removal (Home Care)Mortgage ServicesMortorcycle Sales and ServicesNail CareNew Home PurchaseOffice SuppliesPest ControlPet Supplies and ServicesPharmacyPhoto ProcessingPrinter SuppliesReal EstateRenter's InsuranceRestaurantSatellite TVSchool SuppliesSpa ServicesTanningTax PreperationTiresTraining ProgramsVisionWireless Telephone ServicesWomen's Apparel

	Contact Name*

	Work Phone*

	Address*
	Street:   City:   Zip:

	Email Address*

	Web Address

	Intended Audience*
	All Forsyth County Schools Employees    Specific School (please identify below)

	Details of Offer (please be specific)*

	List any special terms or conditions*

	Expiration Date
	mm/dd/yyyy