BBB: Apply for Accreditation

Business Name: (required)

Doing Business As (DBA):

I wish to provide more BUSINESS NAMES.

Business Address: (required)

City:

Zip/Postal:

State/Province:

Store Number:

Check all that apply:

Mailing Address is the same as the Location Address

Mailing Address: (required)

City:

Zip/Postal:

State/Province:

Corporate HQ City / State:

I wish to provide additional ADDRESS information.

Business Phone: (required)

Business Fax:

Private Phone: (BBB Internal Use Only)

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Cell Phone:

I wish to provide additional PHONE/FAX information.

Principal Contact:

Salutation:

First Name: (required)

Middle:

Last Name: (required)

Suffix:

Title: (required)

Email: (required)

Phone: (required)

Ext:

Fax:

Cell:

Contact this person about any complaints against this business.

Secondary Contact:

Salutation:

First Name:

Middle:

Last Name:

Suffix:

Title:

Email:

Phone:

Ext:

Fax:

Cell:

Contact this person about any complaints against this business.

I wish to provide additional CONTACT PERSON information.

Web Site Address (URL):

I wish to provide additional WEB ADDRESSES.

Public Email:

Request a Quote Email:

Sales Email:

Customer Service Email:

Tech Support Email:

When BBB sends information - such as requests from potential customers - our preferred method of contact is:

Licensing Required?

Yes

Licensing Number:

Agency:

Issued:

Expiration:

I wish to provide additional LICENSING information.

Description of Services/Products:

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Your Service Area:

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What Industry is your Business In?

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Employer Identification Number (EIN):

When and Where did the Business Open: (required)

Date:

April 2024
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State:

Incorporated:

Date:

April 2024
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State:

Type of Business Entity: (required)

Local Business Start Date:

April 2024
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# of Employees: (required)

Average Single Sale ($):

Gross Annual Revenue: $

Additional Notes/Details to BBB:

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- Split Cell Horizontally
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Your name is the same as the Principal Contact

Your Name: (required)

Your Title: (required)

Your Email: (required)

Your Preferred Language:

You may email me about my interest in BBB Accreditation for my business.

I certify that all the information provided in this application is true and accurate to the best of my knowledge & I am authorized to submit this information on behalf of the business.

Cash	Money Order	American Express	Debit Card	Financing
Personal Check	MasterCard	Discover	Automatic Bank Withdrawal	Venmo
Business Check	Visa	PayPal	Online	EFT
Cashiers Check

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