Express Sign-up Form

/Express Sign-up Form
Express Sign-up Form 2017-10-12T05:24:32+00:00

Express Sign-up Form

To sign up TODAY simply submit the Express Sign-up Form below. This opens your Atlantic account.

Next, print our Mailing Label and complete and enclose the following two documents with your first coupon shipment.

  1. Print the Service Agreement.
  2. Print the Questionnaire.

Once we receive your coupons, you will receive a certified receipt. That is it, soon you will receive your first check for the coupons submitted.

Express Sign-up Form

Name of Owner/Officer (required)

Company Name (required)

Address (Store Location) (required)

Mailing Address (if different)

City (required)

State (required)

Zip Code (required)

Phone (required)

Email (required)


Where did you hear about us?

CODE (if applicable)


To open your Atlantic Account, you must agree to the terms of the Express Service Agreement displayed at right.

Check to Accept Terms, then Submit.

Express Service Agreement

Atlantic Coupon Service

Division of PIKS, Inc.

  1. The RETAILER certifies that all coupons forwarded to Atlantic Coupon Services (“ACS”) meet manufacturer’s terms and conditions.
  2. ACS shall sort, count, submit and invoice distributing manufacturers, or their authorized agents, who have authorized ACS to act as a clearinghouse.
  3. The RETAILER will release and discharge the Manufacturer from any and all liability for payment to RETAILER by reason of making said payment to ACS with the exception of pay-direct coupon submissions.
  4. For coupons submitted to the manufacturer on a pay-direct to retailer basis. RETAILER will pay ACS its service charge, included in the payment by the manufacturer.
  5. RETAILER authorizes ACS to maintain a security deposit by deducting a percentage of the amounts otherwise payable to customer as ACS reasonably determines is necessary to cover the cost of rejected coupons or other chargebacks by a Manufacturer.
  6. Upon Manufacturers rejection of a coupon for redemption or any other refusal to pay in a timely manner, ACS shall charge back to RETAILER the full amount charged back by the manufacturer plus a chargeback fee equal to the prevailing handling fee allowed by manufacturers.
  7. In the event of a chargeback, RETAILER shall promptly pay to ACS any unreimbursed amounts. RETAILER further agrees that he/she will be responsible to ACS for any attorney’s fees and costs incurred by ACS in obtaining payment for chargeback.
  8. RETAILER agrees to accept ACS chargeback detail as documentation of manufacturer chargeback or rejection in place of physical coupon(s)
  9. The RETAILER’S coupons will be insured by ACS for loss from fire and theft from the time of receipt, until received by the respective manufacturers.
  10. This agreement shall ensure to the benefit of and be binding upon the parties hereto, their successors and or assigns.
  11. RETAILER agrees to notify ACS within 15 days of any changes of ownership.
  12. RETAILER submits to the jurisdiction of the state of New Jersey and to the Superior Court, Morristown, New Jersey. RETAILER irrevocably waives, to the extend permitted by law, and objection to the venue of any action brought in such court, and any claim that such action has been brought in an inconvenient forum. If RETAILER shall not have appointed an agent for service in New Jersey, RETAILER agrees it may be served by registered or certified mail, postage prepaid, mailed to its last known business address.
  13. This agreement is in force from the date of signing and may be terminated by either side by giving 30 days notice in writing.