Name



|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 |

|«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 |Franchise |If Incorporated, Date & State |

| |( |( |( |( | |

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

|Date Business Established (MM/DD/YY) |NAICS Code (North American Industry Classification) |Number of Employees |

|«date_established» | |«number_of_employees» |

|Primary Type of Business |

|«TOB» |

|Secondary Type of Business |

|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. |

|Gross Annual Revenue |Number of Annual Customers |Number of Locations |

|$ | | |

LICENSING OR BUSINESS REGISTRATION

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

| | | | |

|State Issued | | | |

NAMES, TITLES AND ADDRESSES OF OFFICERS/OWNERS

| |Name |Title |Email |

|Mr. |«send_name» |«contact_title» | |

|Ms. | | | |

|Mr. |Name |Title |Email |

|Ms. | | | |

|Mr. |Name |Title |Email |

|Ms. | | | |

|Mr. |Name |Title |Email |

|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. | | | | |

INFORMATION PROVIDED BY

|Signed By |Title |Date |

|Print Name |Interviewed By |Business Rep |

Are you interested in becoming a BBB Accredited Business? Yes / No

Mail Completed Form to:

Better Business Bureau

4834 Sparks Blvd Ste 102

Sparks, NV 89436

Fax Completed Form to: (775) 322-8163

Email Completed Form to: info@reno.

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

BBB Business Profile

BBB Use Only

BBB File No: «firm_id»

Mailed: «date»

Rating: «rating»

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