Welcome Vendor!

LifeCare^®, Inc. serves nearly 34 million members at over 3,000 companies nationwide. Our unique online LifeMart^SM discount center enables employees to take advantage of pre-negotiated discounts and special offers on a wide variety of products and services nationwide. Vendors seeking to be considered part of this private network may apply below.

* = required information

			Company Name *
			Company Website
			Contact Name *
			Title
			E-mail Address *
			Telephone Number *
			Fax
			Street Address *
			City *
	AK AL AP AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY		State *
			ZIP *
			Description of company services
			Description of specific discount
			Are your discounts local, national, or both? local   national   both
			Are your discount offers redeemable: online   by phone   in store
	Yes No Don't know		Is your company a member of the Better Business Bureau?