company name:

address:

city: state zip code

main phone number:

fax number:

toll-free number or second number:

existing web site address:

existing e-mail:

Describe your type of business:
(i.e., auto repair, fine men's clothing, floral arrangements)

Please classify your company (check all that apply):
business-to-consumer
business-to-business
residential
commercial
non-profit
wholesale
retail
manufacturing
service
other

Do you accept credit cards? yes no
If yes, please specify:
AMEX
Visa
MasterCard
Discover
Diner's Club
ATM/Debit
Other:

Do you offer financing? yes no

If yes, list popular packages/incentives:

Do you carry a product line or special service, etc. your customers would like to know about?
yes no
If yes, please describe:

Do you offer any guarantees or warranties? yes no
If yes, please describe:

Would you like to list your company hours? yes no
Monday - Friday:  Saturday:  Sunday:
Other:
Special Hours:

Would you like to list the date your company was established? yes no
If yes, list date:

If you have more than one location, please list the general geographic area and phone number, i.e. Sugarland 281-555-5555:

What's your niche that customers like to hear about? (i.e. same day service, free delivery)

What other organizations, trade certifications, or licenses would you like listed?

Briefly describe your company, goods, or services to your customer:

Does your company have a slogan you would like to appear?: