For Additional Location Registration (PRINT OUT THIS FORM )  

For Registering Additional Locations for your Business
(Print out one copy for each additional location you wish to register and fax with signed Merchant Application)

Name of Business Location  
Address of Business Location  
Address Continued  
Address Continued  
City  
Country  
State/Province  
Postal Code  
Business Location Phone Number  
Create a Username for this location  
Create a Password for this location  

Fax or Mail this Merchant Location Form(s) along with your signed Merchant Application to:
The DHS Club
2560 Placida Road
Englewood, FL 34224
FAX : 941-475-4081

Acceptance of this application by the DHS Club is not to be considered an approval of the application as it must be manually processed by our HQ Staff during normal business hours.

LY 10/17/03