Registration Form Example

Below is an actual lead capture form that your business will use to create leads and more importantly, more business. The form allows you to capture your new customer’s eMail address and mobile phone # giving you the ability to market your deals and specials to those new people on an on-going basis, either through eMail and/or text message marketing.

You can see how your businesses capture page will look by going to

Take the system for a test drive!

Simply fill out the form below or on the example business page at and you’ll be taken through the process your customers will go through when they register to get (actually you).

Note that the sample page is tied into the sample auto-responder and therefore you may receive (2) eMail’s, one from the submission of the form and/or one from the auto-responder where both eMail’s will have a coupon embeded in it. The auto-responder is set up to send out an eMail immediately when the form is submitted, again three days later and once again seven days after initial sign-up so your new patrons will not forget about coming in and redeeming their gift while bringing friends and family along to enjoy with them (more $’s in your pocket – an average of $78 per table based on National Restaurant Association surveys!!!).

You will only receive (1) eMail if you fill out the form right below as it is not tied into the sample auto-responder.

Are you ready to get started?

REGISTER HERE and we’ll get to work setting up your birthday club so you can start generating more leads, gain more customers and most importantly, increase revenue.


CONGRATULATIONS! You’re only minutes away from claiming your birthday gift on us!

Simply complete the form below, hit the “Submit” button and we’ll provide a coupon entitling you to a birthday gift on us!

Then all you need to do is print out the coupon and give it to the business that you received the coupon from and enjoy your birthday gift. Note also that you can show the coupon to the business by simply presenting it to them on your smart phone, no need to print it out.