New Discount
Request Form

NOTE: North Dakota COSE supports in-state businesses only. Businesses that do not have a state tax ID for the State of North Dakota will not be listed on our discounts page(s).

Thank you for your consideration.

Business Name:

City:
Bismarck area
Dickinson area
Fargo area
Grand Forks area
Jamestown area
Minot area
Williston area
Other / New area
State-wide / Multi-city

Requestor's Phone Number:

Requestor's E-mail Address:

Discount Information to be posted:

Name of Business (as it will be displayed):
   

Address of company (as it will be displayed):
   

Discount being offered (as it will be displayed):