Name



BBB

Standard Business Questionnaire

|Company Name (Corporate or Legal Name) Main Name |

|«company_name» |

|DBAs |

|Main Name |

|Address |City/State |Zip |

|«address»«address_2» |«city»,«state» |«zip» |

|Mailing Address (If Different) |City/State |Zip |

|«mail_address»«mail_address_2» |«mail_city»,«mail_state» |«mail_zip» |

|Telephone Number |Fax Number |

|«phone» |«fax» |

|Additional Telephone Number(s) |Toll-Free Telephone Number |

|( ) |( ) |

|Web Address (URL) |E Mail Address Export Do not Export |

|«url» |«email» |

Please List All Additional Locations and Phone Numbers on a Separate Sheet.

BUSINESS TYPE/CLASSIFICATION/PRODUCT OR SERVICE

|BUSINESS TYPE |Sole Proprietorship |Partnership |Corporation |Other |If Incorporated, Date & State |

|Franchisor Name |

|Corporate Headquarters (State) |Corporate Headquarter (City) |

|Date Business Established (MM/DD/YY) |Length of Time at This Location |Number of Employees |

|«date_established» | |«number_of_employees» |

|Explain any Name/Ownership/Address Changes |

| |

|Describe Products and/or Services Offered |

|«Nature_of_Business» |

| |

|Questions below are for BBB internal use only and help BBB properly determine the size of your business. |

|Annual No. of Customers: |1-500 |501-49,999 |50,000-99,000 |100,000-999,999 |1,000,000+ |

|Annual Revenue: |Less than $1 mil. |$1 mil. - $20 mil. |$20 mil. – 100 mil. |$101 mil – 1 billion |$1 billion + |

|Primary TOB (LISTING IN BBB Intranet Directory) |

|«TOB» |

|Secondary TOB’s (Maximum of 3) |

LICENSING OR BUSINESS REGISTRATION

|Name of Licensing Authority |License Number |Date Issued |Expiration Date |

NAMES, TITLES AND ADDRESSES OF OFFICERS/OWNERS

(Please include middle initial)

|Mr. |Name |Title |Date of Birth (DOB) |

| |«send_name» |«contact_title» | |

|Ms. | | | |

|Mr. |Name |Title |Date of Birth (DOB) |

|Ms. | | | |

|Mr. |Name |Title |Date of Birth (DOB) |

|Ms. | | | |

|Mr. |Name |Title |Date of Birth (DOB) |

|Ms. | | | |

ACCREDITATION CONTACT

If your firm qualifies, would you be interested in BBB Accreditation? If so, please add the name of a contact person below.

|Mr. |Contact Name |Title |Telephone |Fax Number |

| | | |( ) |( ) |

|Ms. | | | | |

COMPLAINT CONTACT

|Mr. |Complaint Contact Name |Title |Telephone |Fax Number |

| | | |( ) |( ) |

|Ms. | | | | |

CORRESPONDENCE CONTACT

|Mr. |Complaint Contact Name |Title |Telephone |Fax Number |

| | | |( ) |( ) |

|Ms. | | | | |

INFORMATION PROVIDED BY

|Signed By |Title |Date |

|Print Name |Interviewed By |Business Rep |

Please return to: Attn: SBQ Enclosed

BBB Serving E WA, N ID & MT

152 S Jefferson St Suite 200, Spokane, WA 99201

Or fax to: 509-838-1079 Attn: SBQ

-----------------------

BBB Use Only

BBB File No: «firm_id»

Mailed: «date»

Rating: «rating»

Assigned to:

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download