*
Required Fields
Business Identification
* Business Name (Main, Corporate or Legal)
Other Business Names(DBA)
* Primary Telephone
Primary Fax
* Primary Address
* City
* State
* Zip
Web Address
Public Email Address
Mailing Address (if different)
City
State
Zip
Additonal locations, phone, fax and email addresses
* 1.
Business Type :
sole proprietorship
partnership
limited liability company
corporation
franchise
other
Other:
Date and State Filed:
Number of Locations
1
2-4
5-9
10-99
100 or more
* 2.
Nature of Business :
manufacturing
distributor
professional
retail sales/service
commercial sales/service
other
Other:
3. To Whom Do You Sell?
retail
wholesale
distributor
other
Other:
4. Type of Local Facility:
plant
warehouse
sales office
retail sales
location service/repair
facility
other
Other:
5. Scope of Business/Marketing:
Local/Southwest Missouri
Regional/Statewide in Missouri
Multi-state
Nationwide
International
Internet
Seasonal/Mobile
6. Gross Annual Revenue (for BBB internal use only):
$1 to $999,999
$1,000,000 to $19,999,999
$20,000,000 to $99,999,999 $100,000,000 to $999,999,999$1,000,000,000 and above
7. Number of Customers annually:
1-9
10-49
50-499
500-4999
5000 or more
7. Number of Employees/Staff/Personnel (for BBB internal use only)
8. Date Business Established Originally:
In Southwest Missouri:
Under New Ownership:
9. Length of Time at This Location
10. Describe Products or Services Offered
Business Category(ies) you are listed under in the Yellow Pages:
Licensing Information
Professional Licensing
Name of Licensing Authority
License Number
Date Issued
Date Expires
State Licensing
Name of Licensing Authority
License Number
Date Issued
Date Expires
City/Local Licensing
Name of Licensing Authority
License Number
Date Issued
Date Expires
Other Licensing
Name of Licensing Authority
License Number
Date Issued
Date Expires
Advertising or Marketing Details
(check all that are applicable)
Other
Give Names, Titles and Addresses and Phone Numbers
of Officers/Owners
Name
Title
Address
City
State
Phone
Email
Name
Title
Address
City
State
Phone
Email
Name
Title
Address
City
State
Phone
Email
Name
Title
Address
City
State
Phone
Email
Give Business History for
the
Past 5 Years for Above Individuals
1.
2.
3.
4.
References If you are interested in accreditation with BBB, please fill out the following references (if applicable)
Local Bank Reference
Name
Telephone
Address
City
State
Business Reference
Name
Telephone
Address
City
State
Customer Reference
Name
Telephone
Address
City
State
Please Provide the Name of a Contact Person that the BBB
can Call for Additional Information
* Contact Name
* Title
* Work Phone
Fax
Email
Please Provide the Name of a
Contact Person who handles complaints for your business
Complaint Contact Name
Title
Work Phone
Fax
Email
How do you prefer to recieve complaints?
Email:
Fax:
Mail:
Information Provided By
* Contact Name
* Title
* Work Phone
Fax
* Please enter the text you see in the image:
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Better Business Bureau -