Better Business Bureau of Middle Tennessee, Inc.

THIS IS NOT AN APPLICATION FOR MEMBERSHIP WITH BBB. By completing this form, you will provide BBB with basic business information on your company. This information will be used to compile your BBB Reliability Report. If your firm qualifies, may BBB contact you about membership?

Yes

Basic Information

Firm Name (Corporate or Legal Name)

Other Business Names (DBA)

Telephone

Fax

Address

City/State

Zip

Website Address

Chief Executive

Name/Title of Chief Executive:

Customer Service Contact

Customer Service Contact Name

Address

City/State

Customer Service Contact Telephone

Mailing Address

Mailing Address (if different)

City/State

Zip

Corporate Office

Parent Company Name and Address (if applicable)

Business History / Business Type

Date Business Established

Type of Business

Other

If incorporated, give date and state

Number of Employees

Nature of Business

Describe Products or Services Offered

Licensing (if required)

Name of Licensing Authority

License Number

Date Issued

Date Expires

Resident Information for Each Executive (confidential)

Name:

Title:

Address

Name:

Title:

Address:

Name:

Title:

Address:

Previous Experience

If your business is less than 5 years old, please provide the specific business experience of each principal officer.

By Clicking "Register Your Company" you are certifying that all of the information submited on this form is true and accurate and that you are an authorized representative of the company.

Name:

Title:

Telephone: