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<form action="https://www.snapretail.com/retailer/ConsumerSignupForm.aspx/Save?DataCollectionType=EmbeddedWebForm" method="post" target="_blank"><input id="Token" name="Token" type="hidden" value="qxyqWXdI509HTaWUlftNrQ" />


<div class="collectEmailFormGroup">
<h5>Join Our Mailing List</h5>
</div>


<div class="collectEmailFormGroup">
<div class="label-error-group">
<label for="EmailAddress">Email Address*</label>
<span class="field-validation-valid validation-message" data-valmsg-for="EmailAddress" data-valmsg-replace="true"></span>
</div>
<input data-val="true" data-val-required="Required" id="EmailAddress" maxlength="255" name="EmailAddress" placeholder="you@email.com" type="email" value="" />
</div>


<div class="collectEmailFormGroup">
<div class="label-error-group">
<label for="FirstName">Name or Name of Store*</label> <span class="field-validation-valid validation-message" data-valmsg-for="FirstName" data-valmsg-replace="true"></span>
</div>
<input id="FirstName" maxlength="255" name="FirstName" placeholder="Mary" type="text" value="" />
</div>


<div class="collectEmailFormGroup">
<span>*required</span>
</div>

<div class="collectEmailFormGroup collectEmailFormActions">
<button type="submit" class="btn">Submit</button>
</div>

</form>
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Redeems to
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