Bama Perks Vendor Form

Important: Please review the Bama Perks Guidelines before completing this form.

Business Name(Required)

Full Company Name

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone(Required)

Business Website(Required)

Business Email(Required)

Enter Email Confirm Email

Name/Position of Authorized Contact(Required)

First Last Position

Authorized Contact Phone(Required)

Authorized Contact Email(Required)

Discount Offered(Required)

Discount Description(Required)

Please provide a brief description of your discount offer as you would like it to appear on the website, including any restrictions and/or requirements.

Please list how to redeem this discount (i.e., present valid ActCard at checkout, etc.)(Required)

Contact the HR Service Center for questions or additional information at (205) 348-7732 or hr@ua.edu.