RHINOS' NATION - "Needs & Wants" Survey Form

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Please fill out and submit this form to activate your Rhinos' Nation Annual Membership.

"HUGE SAVINGS SHOPPING With Our QUALITY BLACK OWNED BUSINESSES"

Here is how it works:

To get you started on your HUGE SAVINGS, just fill out the form and submit it today! Just think of the things you may "NEED & WANT" for your personal use to Purchase and SAVE with your Rhinos' Nation Membership Discount!

One of our great benefits is that we will be using your personal shopping list below on things you "NEED & WANT" to recruit more Quality BLACK Owned Businesses on our TEAM to help you save money while shopping!

Please fill out the form below so that we, Rhinos' Nation, can best serve you!

We will follow up with you after we receive your completed form! If you have any questions on this matter please contact us as soon as possible. Check with us on our rules and guidelines.

* Your personal information from this form will not be given or sold to any third-party companies!

Please Do Not use All CAPS to fill out this form. Thank you.

Email *

Name (First & Last) *

City/State *

Phone Number *

Company Name (optional)

"NEEDS & WANTS LIST" *

Check all below, which you may need and want to purchase and SAVE while shopping:

Accountants

Air Conditioning (Purchases / Repairs)

Apartments (Search)

Appliances (Purchases / Repairs)

Art (Pictures / Sculptures)

Attorneys

Automotives

Baby Accessories & Services

Baby Setting Services

Bakeries

Banks

Banquet Facilities

Barber Shops

Beauty Salon Visits

Beauty Supplies / Cosmetics

Bicycles (Bikes)

Books

Bridal Shops

Burglar Alarm Systems

Buses (Charter / Tours / Rental)

Candles

Candy & Confectionery

Carpet (Cleaning / Installation)

Cars (Purchases / Repairs)

Catering

Cell Phones (Purchases / Services)

Child Care Services (Day Care / After School Care)

Child Care Services (For Special Events, Only)

Clothes (Children) and Accessories

Clothes (Infants/Toddlers) and Accessories

Clothes (Men) and Accessories

Clothes (Women) and Accessories

Coffee

Computers (Purchases / Repairs)

Cosmetics

Cruises

Day Care Centers

Dentists

Desserts

Diets

Doctors

Dolls

Draperies & Curtains

Dry Cleaners

Electrical (Services / Supplies)

Electronic (Equipment / Supplies)

Embroidery

Estates

Event Center Leasing

Event Planning

Exercise

Exterminators (Pest Control)

Eye Glasses and Care

Fences

Financial (Planners / Services)

Fire Alarm Systems

Florists

Food (Farms / Grocery Stores, etc.)

Foreclosures

Furniture - Home

Furniture - Office

Games

Garages

Garden (Plants / Supplies)

Gift Baskets

Gift Shops

Golf (To Play / To Purchase Clubs, Equipment and Supplies)

Graphic Designs (Flyers / Logos, etc.)

Greeting Cards

Grocery Stores

Gym Membership

Hair (Purchases)

Hair Care (Services / Supplies)

Handicapped Services

Hardware

Health (Care / Plans)

Health and Fitness

Heating/Air Conditioning

Home Businesses

Home Designs & Planning

Home Cleaning Services

Home Furniture

Home Repairs (Painting / HVAC / Floors / Roofing, etc.)

Home Supplies

Horses

Hotel Stay

Household Goods (Brooms / Mops / Dishwashing Liquid / Washing Detergent, etc.)

Ice

Ice Cream

Identification Cards

Insurance

Interior Decorators

Internet Services

Investments

Jewelry

Judo & Jiu-Jitsu

Karaoke

Karate

Keys

Kitchenware (Plates / Pot and Pans / Silverware, etc.)

Laundries

Lawn Care Services / Supplies

Legal Services

Limo Services

Locks & Locksmiths

Luggage

Manicures

Marriage Consultants

Martial Arts

Massage Therapists

Mobile Apps (Designs)

Mobile Homes

Mobile Phones

Motorcycles / 3-Wheelers / 4-Wheelers

Mortgages

Moving & Storage Companies (Residential / Commercial)

Musical Instruments

Museums

Nails

Nurseries (Plants / Trees)

Nurses

Office Furniture

Office (Products / Supplies)

Office Space

Opticians

Organic Foods

Organic Health Products

Personal Meal Prep (Chefs)

Personal Trainers

Pest Control (Products / Services)

Pets

Phones (Products / Services)

Photographers

Physicians

Plants

Pools/Spas

Popcorn

Printing (Banners / Flyers / Post Cards, etc.)

Quilting

Real Estate

Refrigerator

Restaurants (Dining In / Deliveries / Take-outs)

Retirement & Life Care

Roofing

Schools

School Supplies

School Uniforms

Security Systems

Skin Care Products

Smart Phones (Products / Services)

Soaps

Spa Visits / Memberships

Storage Units (Leasing)

Tax Services

Televisions (Purchases / Services)

Toiletries (Shampoo / Soap / Toothpaste, etc.)

Tools

Tours

Toys (Children)

Travel Agencies

Trucks

Trophies & Awards

Tutors

Tuxedos

Uniforms

Vacation / Travel

Veterinarians

Videos

Website (Designs and Hosting)

Wedding Consultants

Wedding Gowns and Accessories

Wedding Planners

Weight Lost

Work Uniforms

Youth Centers

Required

Please list other purchases you may wish to make with Quality BLACK Owned Businesses, below. Please separate with commas.

Gender *

Male

Female

Did anyone refer you to us? Let us know!

Comments, Questions, & Additional Information

If you have any questions on this matter please contact us!

Email: membership@rhinosnation.com
Phone: 901.454.3267
Web: www.rhinosnation.com

Rebuilding A BLACK Nation!

A copy of your responses will be emailed to the address you provided.

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