Business Application for online use of BBB Accredited Business Seal

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Business Information
Name of business applying for a seal:
Corporate Business Name:  
Headquarters Address:
City:  
State/Province: (e.g. VA)
Zip/Postal Code:  
Country:
  
Main Phone Number:  
Main Fax Number:
Primary URL:  
Additional URL's:
(Please use comma (,) to separate)		  
Primary Email:  
Number of Employees:  
Date Business Started:  
Is your business BBB Accredited?
  
What type of business is this? (Please provide a brief description of products or services offered online.)

150 characters left
Keywords: Please provide keywords that best represent your website. These keywords will be used to identify your business in the BBBOnLine participants search engine. (use comma to separate keywords)

250 characters left
Contact Information
President/CEO/Owner
First Name:  
 Last Name:  
Title: Email:  
Phone:   Ext.:  
Customer Service Same as President/CEO/Owner
First Name:  
 Last Name:  
Title: Email:  
Phone:   Ext.:  
Technical Contact Same as President/CEO/Owner
First Name:  
 Last Name:  
Title: Email:  
Phone:   Ext.:  
Person filling out this form Same as President/CEO/Owner
First Name:  
 Last Name:  
Title: Email:  
Phone:   Ext.:  
Account Information
You will use your username and password to access and manage your account. This may include updating your account information and applying for renewal.
Username:
Username Already Exists!
Your username must be at least four letters and numbers (no spaces, please.) If the username you choose is already taken, we will ask you to choose another.
Password: Your password must at least four letters and numbers. You should select a password which you can easily remember.
Confirm
Password:

 
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