Retail Partner Registration

APPLICANT INFORMATION
First Name:*

Last Name:*

Position / Title  *

Company / Organization Name:*

Address:*

Address 2:

City:*

Island / State:* 

Zip code:*
  

CONTACT INFORMATION
Phone: (e.g. ###-###-#### x Ext.)*
Mobile Phone: (e.g. ###-###-####)
 
E-mail:* (use your Agency email address)
 
Create a Password:* (Retail Partner Only Access)

TRADE ASSOCIATION AFFILIATION
(e.g. Retail Merchants Association, Retail Grocers Association,
Retail Liquor Dealers Association, etc.) 

REFERRED BY*
 

I Agree
In an effort to improve communications and assist Law Enforcement in identifying illicit individuals and Organized Retail Crime (ORC) networks, MLRIN has established a secure website where local retailers and businesses are able to post and review information of a confidential nature to assist Law Enforcement in identifying said individuals. The information contained on the website is for MLRIN members' use only. Any unauthorized release, copying, distribution of any of the information contained herein will result in the termination of access to this site and may expose an individual or corporation to legal liability. I understand the above stated guidelines and will abide by them. I understand that information on the website can be removed at the webmasters discretion at any time. I also understand and agree that failure on my behalf to abide by the information above will be grounds for dismissal from further participation in the program.

The final determination as to who has access to the MLRIN website belongs to the MLRIN Membership Committee and will be made based on a number of criteria designed to maintain the security of the information hosted